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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity
(AOB) Assignment of Benefits
(ABN) Advance Beneficiary Notice
ordering physician
ee schedule
2. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan
health care provider
Network
Notice of Privacy Practices
Participating Provider
3. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(DRG's)
(POS) Point-of Service Plan
Specialist
authorization form
4. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations
authorization form
(UCR) Usual - Customary and Reasonable
(APC) Ambulatory Patient Classifications
complience
5. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
nonprivileged information
(DRG's)
Claim
medical foundation
6. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.
ethics
health care provider
attending physician
Assignment & Authorization
7. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
etiquette
Network
preauthorization
consent
8. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Notice of Privacy Practices
(PAC) Pre- Admission Certification
Pre-certification
covered entity
9. 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.
consulting physician
etiquette
Privacy officer
medical foundation
10. Medical services provided on an outpatient basis
(ERISA) Employee Retirement Income Security Act of 1974
Amblatory Care
(PCP) Primary Care Physician
e-health information management
11. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(PCP) Primary Care Physician
state preemption
(UCR) Usual - Customary and Reasonable
Consent form
12. An intentional misrepresentation of the facts to deceive or mislead another.
Allowed Expenses
fraud
Sub-acute Care
medical foundation
13. 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
fraud
ppo
hmo
covered entity
14. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Coordinated Coverage
(EPO) Exclusive Provider Organization
Coordinated Coverage
business associate
15. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.
Preauthorization
health care provider
Network
IIHI
16. 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
business associate
pos
(COBRA)
referral
17. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
(PAC) Pre- Admission Certification
Embezzlement
security officer
18. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
Pre-existing Condition Exclusion
(DRG's)
(TPA) Third Party Administrator
open panel HMO
19. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
business associate
(AOB) Assignment of Benefits
Allowed Expenses
Network
20. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
hmo
Privacy officer
econdary Payer
Consent form
21. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
consulting physician
health care provider
AMA
22. 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
Amblatory Care
e-health information management
Supplementary Medical Insurance
prepaid plan
23. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
business associate
etiquette
Coordinated Coverage
Resonable Charge
24. 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
Participating Provider
Preauthorization
nonprivileged information
(COBRA)
25. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
pos
Claim
(PAC) Pre- Admission Certification
Assignment & Authorization
26. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
transaction
Medigap Insurance
premium
consulting physician
27. American Medical Association
(OOPs) Out of Pocket Costs/Expenses
AMA
(DME) Durable Medical Equipment
(AOB) Assignment of Benefits
28. 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
benefit period
IIHI
(PEC) Pre-existing condition
econdary Payer
29. The amount of actual money available to the medical practice
authorization form
cash flow
Preauthorization
Confidential communication
30. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
HIPAA
closed panel HMO
consulting physician
31. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
Coordinated Coverage
Protected health information
cash flow
32. The transmission of information between two parties to carry out financial or administrative activities related to health care.
referral
Out of Network (OON)
etiquette
transaction
33. A nonprofit integrated delivery system
medical foundation
Claim
Supplementary Medical Insurance
abuse
34. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
Pre-existing Condition Exclusion
Resonable Charge
pos
authorization form
35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
business associate
consent
Pre-certification
36. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Individually identifiable health information
ee schedule
abuse
claim
37. 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
transaction
Consent form
Network
epo
38. Customs - rules of conduct - courtesy - and manners of the medical profession
(TPA) Third Party Administrator
Pre-certification
cash flow
etiquette
39. 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.
Protected health information
transaction
Specialist
(PAC) Pre- Admission Certification
40. Individually identifiable health information
Individually identifiable health information
IIHI
clearinghouse
(UR) Utilization review
41. Is a provider who sends the patients for testing or treatment
referring physician
crossover claim
(PCN) Primary Care Network
Maximum Out Of Pocket
42. 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
HIPAA
Preauthorization
(POS) Point-of Service Plan
Deductible
43. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(ABN) Advance Beneficiary Notice
confidentiality
Deductible
(EPO) Exclusive Provider Organization
44. The maximum amount a plan pays for a covered service
Participating Provider
ee schedule
Specialist
Allowed Expenses
45. 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
complience
premium
phantom billing
46. 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.
Pre-certification
Pre-existing Condition Exclusion
attending physician
Protected health information
47. A rule - condition - or requirement
(DOS) Date of Service
(PCP) Primary Care Physician
(Non-par) Non-Participating Provider
Standard
48. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Deductible
Consent form
Supplementary Medical Insurance
business associate
49. 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
Supplementary Medical Insurance
covered entity
benefit period
(UR) Utilization review
50. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor
Deductible
covered entity
Allowed Expenses
Assignment & Authorization