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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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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. Health Information Portability and Accountability Act
Experimental Procedures
(Non-par) Non-Participating Provider
Resonable Charge
HIPAA
2. 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.
security officer
Subscriber
ids
clearinghouse
3. 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
IIHI
Assignment & Authorization
(Non-par) Non-Participating Provider
Embezzlement
4. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
etiquette
Network
Privileged information
complience
5. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
ppo
(APC) Ambulatory Patient Classifications
Deductible
6. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Deductible
cash flow
hmo
epo
7. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
complience
phantom billing
(UR) Utilization review
Preauthorization
8. 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
Claim
breach of confidential communication
self-referral
(PCN) Primary Care Network
9. 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
(COBRA)
pos
ordering physician
Amblatory Care
10. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Embezzlement
e-health information management
Pre-certification
(UR) Utilization review
11. Verbal or written agreement that gives approval to some action - situation - or statement.
pcp
subscriber
consent
(AOB) Assignment of Benefits
12. 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
(COB) Coordination of Benefits
epo
Out of Network (OON)
(PPS) Hospital Impatient Prospective Payment System
13. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
(POS) Point-of Service Plan
covered entity
nonprivileged information
14. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
open panel HMO
disclosure
Privacy officer
business associate
15. A privileged communication that may be disclosed only with the patient's permission.
e-health information management
(PPS) Hospital Impatient Prospective Payment System
(EPO) Exclusive Provider Organization
Confidential communication
16. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
(ERISA) Employee Retirement Income Security Act of 1974
epo
(APC) Ambulatory Patient Classifications
17. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Embezzlement
Medigap Insurance
transaction
covered entity
18. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
referral
subscriber
Embezzlement
premium
19. A nonprofit integrated delivery system
health care provider
medical foundation
Medigap Insurance
consulting physician
20. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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21. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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22. Is a provider who sends the patients for testing or treatment
Amblatory Care
Out of Network (OON)
(COBRA)
referring physician
23. 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
nonprivileged information
(AOB) Assignment of Benefits
HIPAA
(DOS) Date of Service
24. Is the provider who renders a service to a patient
Assignment & Authorization
Participating Provider
Treating or performing physician
Coordinated Coverage
25. Medical services provided on an outpatient basis
(POS) Point-of Service Plan
(PEC) Pre-existing condition
prepaid plan
Amblatory Care
26. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
(DME) Durable Medical Equipment
Medigap Insurance
benefit period
27. 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
prepaid plan
phantom billing
Claim
28. 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.
Consent form
consulting physician
IIHI
health care provider
29. 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
Consent form
Embezzlement
IIHI
Open Enrollment
30. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Assignment & Authorization
disclosure
claim
authorization form
31. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Maximum Out Of Pocket
Assignment & Authorization
closed panel HMO
complience plan
32. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
etiquette
ee schedule
fraud
33. Someone who is eligible for or receiving benefits under an insurance policy or plan
nonprivileged information
econdary Payer
Preauthorization
Beneficiary
34. A monthly fee paid by the insured for specific medical insurance coverage
Specialist
(PCP) Primary Care Physician
preauthorization
premium
35. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
econdary Payer
Resonable Charge
nonprivileged information
(UCR) Usual - Customary and Reasonable
36. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
Network
(DRG's)
Embezzlement
37. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment
ppo
(DME) Durable Medical Equipment
(COBRA)
(AOB) Assignment of Benefits
38. An organization of provider sites with a contracted relationship that offer services
Claim
Medigap Insurance
Preauthorization
ids
39. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(PPS) Hospital Impatient Prospective Payment System
Claim
Network
(ERISA) Employee Retirement Income Security Act of 1974
40. 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
(Non-par) Non-Participating Provider
Specialist
Participating Provider
Open Enrollment
41. 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
closed panel HMO
Referral
(UR) Utilization review
(Non-par) Non-Participating Provider
42. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
attending physician
business associate
(APC) Ambulatory Patient Classifications
hmo
43. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Sub-acute Care
pcp
Confidential communication
44. A structure for classifying outpatient services and procedures for purpose of payment
Protected health information
(Non-par) Non-Participating Provider
Maximum Out Of Pocket
(APC) Ambulatory Patient Classifications
45. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
nonprivileged information
complience plan
Individually identifiable health information
(DOS) Date of Service
46. Unauthorized release of information
phantom billing
business associate
breach of confidential communication
Preauthorization
47. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Maximum Out Of Pocket
breach of confidential communication
Specialist
Network
48. Is the provider who renders a service to a patient
ids
Notice of Privacy Practices
Treating or performing physician
Pre-existing Condition Exclusion
49. A nonprofit integrated delivery system
prepaid plan
referring physician
medical foundation
Sub-acute Care
50. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
e-health information management
(EPO) Exclusive Provider Organization
Specialist
referring physician
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