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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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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. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
Sub-acute Care
e-health information management
security officer
preauthorization
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.
(DCI) Duplicate Coverage Inquiry
Sub-acute Care
Individually identifiable health information
Assignment & Authorization
3. Unauthorized release of information
electronic media
(APC) Ambulatory Patient Classifications
breach of confidential communication
Embezzlement
4. 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
covered entity
(PCN) Primary Care Network
pos
Coordinated Coverage
5. 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
econdary Payer
Assignment & Authorization
Open Enrollment
state preemption
6. 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)
Consent form
(COB) Coordination of Benefits
(OOPs) Out of Pocket Costs/Expenses
(ERISA) Employee Retirement Income Security Act of 1974
7. 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
(PCN) Primary Care Network
medical foundation
Participating Provider
medical foundation
8. 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
(APC) Ambulatory Patient Classifications
Preauthorization
cash flow
claim
9. A clinic that is owned by the HMO and the physicians are employees of the HMO
Open Enrollment
ee schedule
closed panel HMO
IIHI
10. A review of the need for inpatient hospital care - completed before the actual admission
(EPO) Exclusive Provider Organization
Notice of Privacy Practices
Consent form
(PAC) Pre- Admission Certification
11. Medicare's method of paying acute care hospitals for inpatient care
claim
(PPS) Hospital Impatient Prospective Payment System
Maximum Out Of Pocket
(AOB) Assignment of Benefits
12. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Privileged information
Pre-certification
(PPS) Hospital Impatient Prospective Payment System
pcp
13. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
self-referral
(DRG's)
Preauthorization
(UCR) Usual - Customary and Reasonable
14. 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.
referring physician
(AOB) Assignment of Benefits
state preemption
prepaid plan
15. 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
open panel HMO
(PPS) Hospital Impatient Prospective Payment System
fraud
16. 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
econdary Payer
ordering physician
(AOB) Assignment of Benefits
security officer
17. 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)
Amblatory Care
e-health information management
(DME) Durable Medical Equipment
Consent form
18. A rule - condition - or requirement
(PAC) Pre- Admission Certification
complience plan
Standard
phantom billing
19. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
electronic media
(DRG's)
subscriber
20. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
state preemption
(PPS) Hospital Impatient Prospective Payment System
Participating Provider
21. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
HIPAA
complience plan
confidentiality
Specialist
22. A list of the amount to be paid by an insurance company for each procedure service
hmo
claim
breach of confidential communication
ee schedule
23. 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
etiquette
ppo
business associate
(PAC) Pre- Admission Certification
24. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
consent
electronic media
Preauthorization
Network
25. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.
etiquette
Subscriber
(UCR) Usual - Customary and Reasonable
security officer
26. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Assignment & Authorization
Referral
self-referral
consulting physician
27. Individually identifiable health information
(TPA) Third Party Administrator
IIHI
confidentiality
(Non-par) Non-Participating Provider
28. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
covered entity
IIHI
medical foundation
29. Medical services provided on an outpatient basis
Amblatory Care
ordering physician
Specialist
Assignment & Authorization
30. 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
Assignment & Authorization
Experimental Procedures
preauthorization
Out of Network (OON)
31. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
consent
pcp
econdary Payer
Amblatory Care
32. An organization of provider sites with a contracted relationship that offer services
ids
Supplementary Medical Insurance
Experimental Procedures
(AOB) Assignment of Benefits
33. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Embezzlement
abuse
etiquette
Preauthorization
34. American Medical Association
(DOS) Date of Service
(Non-par) Non-Participating Provider
AMA
phantom billing
35. Is a provider who sends the patients for testing or treatment
referring physician
(COB) Coordination of Benefits
complience plan
ppo
36. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
AMA
Sub-acute Care
Standard
Security Rule
37. 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
prepaid plan
Privileged information
covered entity
ethics
38. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
hmo
electronic media
(ERISA) Employee Retirement Income Security Act of 1974
attending physician
39. 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
medical foundation
Resonable Charge
pcp
prepaid plan
40. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Assignment & Authorization
consulting physician
Pre-existing Condition Exclusion
(UR) Utilization review
41. 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
(PCP) Primary Care Physician
preauthorization
Experimental Procedures
Maximum Out Of Pocket
42. 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.
Protected health information
health care provider
Claim
attending physician
43. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Medigap Insurance
(TPA) Third Party Administrator
Resonable Charge
Privileged information
44. The period of time that payment for Medicare inpatient hospital benefits are available
complience plan
complience plan
Deductible
benefit period
45. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Notice of Privacy Practices
Deductible
(COBRA)
46. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
Privileged information
(UCR) Usual - Customary and Reasonable
etiquette
(PEC) Pre-existing condition
47. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
electronic media
Subscriber
Open Enrollment
(COBRA)
48. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
hmo
Experimental Procedures
(AOB) Assignment of Benefits
Maximum Out Of Pocket
49. The maximum amount a plan pays for a covered service
Specialist
Allowed Expenses
phantom billing
Referral
50. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
consulting physician
ppo
nonprivileged information
preauthorization