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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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study here
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.
Sub-acute Care
Pre-certification
Privileged information
Notice of Privacy Practices
2. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
deductible
e-health information management
Individually identifiable health information
consent
3. Is the provider who renders a service to a patient
covered entity
Pre-existing Condition Exclusion
Treating or performing physician
(DME) Durable Medical Equipment
4. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
preauthorization
Network
IIHI
(ERISA) Employee Retirement Income Security Act of 1974
5. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Subscriber
(PEC) Pre-existing condition
electronic media
(ABN) Advance Beneficiary Notice
6. A health insurance enrollee chooses to see an out of network provider without authorization
(DCI) Duplicate Coverage Inquiry
Covered Expenses
self-referral
(POS) Point-of Service Plan
7. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
self-referral
Confidential communication
(PCP) Primary Care Physician
Subscriber
8. A rule - condition - or requirement
(POS) Point-of Service Plan
Standard
business associate
security officer
9. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
(DOS) Date of Service
(UR) Utilization review
authorization form
10. The condition of being secluded from the presence or view of others.
privacy
subscriber
ee schedule
Protected health information
11. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
Security Rule
open panel HMO
(COBRA)
Referral
12. The period of time that payment for Medicare inpatient hospital benefits are available
(COB) Coordination of Benefits
Pre-existing Condition Exclusion
Subscriber
benefit period
13. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
Privacy officer
ethics
attending physician
complience plan
14. American Medical Association
AMA
transaction
open panel HMO
Amblatory Care
15. Standards of conduct generally accepted as a moral guide for behavior.
ethics
(PPS) Hospital Impatient Prospective Payment System
(DOS) Date of Service
(ABN) Advance Beneficiary Notice
16. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
electronic media
pos
cash flow
prepaid plan
17. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
confidentiality
etiquette
Assignment & Authorization
subscriber
18. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Resonable Charge
epo
(AOB) Assignment of Benefits
19. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
disclosure
Protected health information
Standard
fraud
20. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
premium
(PEC) Pre-existing condition
(DOS) Date of Service
21. What the insurance company will consider paying for as defined in the contract.
consent
Supplementary Medical Insurance
referral
Covered Expenses
22. A nonprofit integrated delivery system
Supplementary Medical Insurance
medical foundation
Allowed Expenses
state preemption
23. Customs - rules of conduct - courtesy - and manners of the medical profession
state preemption
etiquette
Claim
ppo
24. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
epo
(ABN) Advance Beneficiary Notice
Notice of Privacy Practices
covered entity
25. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Assignment & Authorization
(PPS) Hospital Impatient Prospective Payment System
abuse
Network
26. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(ABN) Advance Beneficiary Notice
(COBRA)
Covered Expenses
(DCI) Duplicate Coverage Inquiry
27. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method
attending physician
epo
Assignment & Authorization
Supplementary Medical Insurance
28. The maximum amount a plan pays for a covered service
(PCN) Primary Care Network
HIPAA
prepaid plan
Allowed Expenses
29. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
(PAC) Pre- Admission Certification
referring physician
(OOPs) Out of Pocket Costs/Expenses
(PCN) Primary Care Network
30. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
(TPA) Third Party Administrator
closed panel HMO
Deductible
Preauthorization
31. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
econdary Payer
cash flow
(TPA) Third Party Administrator
Assignment & Authorization
32. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Beneficiary
pcp
Allowed Expenses
Participating Provider
33. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
Specialist
Specialist
privacy
34. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
Open Enrollment
hmo
Amblatory Care
crossover claim
35. An organization of provider sites with a contracted relationship that offer services
Maximum Out Of Pocket
(PEC) Pre-existing condition
Pre-certification
ids
36. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
(POS) Point-of Service Plan
covered entity
fraud
phantom billing
37. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
(OOPs) Out of Pocket Costs/Expenses
(TPA) Third Party Administrator
nonprivileged information
etiquette
38. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Referral
(AOB) Assignment of Benefits
preauthorization
Allowed Expenses
39. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
e-health information management
ordering physician
self-referral
40. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
(ERISA) Employee Retirement Income Security Act of 1974
Coordinated Coverage
self-referral
(PPS) Hospital Impatient Prospective Payment System
41. American Medical Association
transaction
(EPO) Exclusive Provider Organization
AMA
Open Enrollment
42. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Pre-existing Condition Exclusion
epo
claim
ethics
43. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
econdary Payer
IIHI
(OOPs) Out of Pocket Costs/Expenses
(EPO) Exclusive Provider Organization
44. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
Coordinated Coverage
premium
state preemption
Supplementary Medical Insurance
45. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
(PCP) Primary Care Physician
Covered Expenses
hmo
Preauthorization
46. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(DRG's)
Deductible
pos
47. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
ppo
Consent form
Beneficiary
Maximum Out Of Pocket
48. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
premium
(COBRA)
Medigap Insurance
(UCR) Usual - Customary and Reasonable
49. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
(DME) Durable Medical Equipment
Out of Network (OON)
(UR) Utilization review
abuse
50. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Out of Network (OON)
health care provider
pos
clearinghouse