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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.
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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. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
econdary Payer
epo
(Non-par) Non-Participating Provider
2. A health insurance enrollee chooses to see an out of network provider without authorization
state preemption
self-referral
(AOB) Assignment of Benefits
Beneficiary
3. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
prepaid plan
state preemption
business associate
(PEC) Pre-existing condition
4. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
closed panel HMO
claim
(DRG's)
Preauthorization
5. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
electronic media
Privacy officer
premium
(EPO) Exclusive Provider Organization
6. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Medigap Insurance
(ERISA) Employee Retirement Income Security Act of 1974
(Non-par) Non-Participating Provider
(OOPs) Out of Pocket Costs/Expenses
7. Health Information Portability and Accountability Act
referring physician
pos
HIPAA
Network
8. 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.
breach of confidential communication
state preemption
Coordinated Coverage
health care provider
9. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
IIHI
Covered Expenses
deductible
Consent form
10. The maximum amount a plan pays for a covered service
(PPS) Hospital Impatient Prospective Payment System
epo
preauthorization
Allowed Expenses
11. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare
pos
(Non-par) Non-Participating Provider
cash flow
Pre-existing Condition Exclusion
12. A privileged communication that may be disclosed only with the patient's permission.
(EPO) Exclusive Provider Organization
phantom billing
referring physician
Confidential communication
13. What the insurance company will consider paying for as defined in the contract.
business associate
(DRG's)
(UR) Utilization review
Covered Expenses
14. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
breach of confidential communication
ordering physician
disclosure
(ABN) Advance Beneficiary Notice
15. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
state preemption
covered entity
(EPO) Exclusive Provider Organization
attending physician
16. A monthly fee paid by the insured for specific medical insurance coverage
prepaid plan
premium
(PEC) Pre-existing condition
etiquette
17. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
AMA
(PEC) Pre-existing condition
ppo
Open Enrollment
18. Medical staff member who is legally responsible for the care and treatment given to a patient.
self-referral
attending physician
(DOS) Date of Service
open panel HMO
19. An intentional misrepresentation of the facts to deceive or mislead another.
clearinghouse
fraud
premium
Referral
20. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
health care provider
disclosure
phantom billing
21. A patient claim is eligible for medicare and medicaid
crossover claim
privacy
clearinghouse
Resonable Charge
22. 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.
Notice of Privacy Practices
Pre-certification
fraud
HIPAA
23. The maximum amount a plan pays for a covered service
(PCP) Primary Care Physician
(PAC) Pre- Admission Certification
(COBRA)
Allowed Expenses
24. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
(PCN) Primary Care Network
ee schedule
(DRG's)
25. 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.
ee schedule
state preemption
crossover claim
covered entity
26. 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
Individually identifiable health information
ethics
(ABN) Advance Beneficiary Notice
Security Rule
27. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Maximum Out Of Pocket
IIHI
(AOB) Assignment of Benefits
28. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Subscriber
privacy
complience plan
complience
29. 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.
disclosure
security officer
open panel HMO
Pre-certification
30. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Participating Provider
Network
(PAC) Pre- Admission Certification
Confidential communication
31. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Pre-certification
ordering physician
Specialist
electronic media
32. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
(OOPs) Out of Pocket Costs/Expenses
subscriber
(ERISA) Employee Retirement Income Security Act of 1974
33. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
IIHI
clearinghouse
epo
Individually identifiable health information
34. 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
Consent form
complience plan
(ABN) Advance Beneficiary Notice
35. An intentional misrepresentation of the facts to deceive or mislead another.
preauthorization
fraud
Specialist
(DRG's)
36. 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
attending physician
Treating or performing physician
nonprivileged information
Embezzlement
37. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Out of Network (OON)
hmo
(DOS) Date of Service
HIPAA
38. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Amblatory Care
referral
crossover claim
ordering physician
39. 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)
Referral
claim
etiquette
Consent form
40. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(PCP) Primary Care Physician
(DCI) Duplicate Coverage Inquiry
Resonable Charge
(APC) Ambulatory Patient Classifications
41. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
deductible
(PAC) Pre- Admission Certification
etiquette
Claim
42. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
referring physician
Specialist
claim
Resonable Charge
43. Billing for services not performed
phantom billing
IIHI
(APC) Ambulatory Patient Classifications
preauthorization
44. A list of the amount to be paid by an insurance company for each procedure service
breach of confidential communication
deductible
ee schedule
privacy
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
electronic media
transaction
abuse
46. 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
(COB) Coordination of Benefits
Preauthorization
(COB) Coordination of Benefits
Allowed Expenses
47. Medical services provided on an outpatient basis
Amblatory Care
econdary Payer
(UCR) Usual - Customary and Reasonable
Notice of Privacy Practices
48. 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
phantom billing
Supplementary Medical Insurance
Sub-acute Care
complience plan
49. 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
clearinghouse
consent
(PCN) Primary Care Network
(UR) Utilization review
50. 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
(AOB) Assignment of Benefits
Maximum Out Of Pocket
ethics
health care provider