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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
clearinghouse
confidentiality
(OOPs) Out of Pocket Costs/Expenses
2. 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.
complience
Individually identifiable health information
health care provider
(UCR) Usual - Customary and Reasonable
3. 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
nonprivileged information
consent
(Non-par) Non-Participating Provider
preauthorization
4. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
consent
open panel HMO
benefit period
Standard
5. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Supplementary Medical Insurance
Specialist
privacy
health care provider
6. The period of time that payment for Medicare inpatient hospital benefits are available
referring physician
Protected health information
claim
benefit period
7. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
complience
(PAC) Pre- Admission Certification
preauthorization
8. 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
hmo
abuse
Out of Network (OON)
security officer
9. 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
(ABN) Advance Beneficiary Notice
(DCI) Duplicate Coverage Inquiry
(OOPs) Out of Pocket Costs/Expenses
Preauthorization
10. 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.
Deductible
business associate
nonprivileged information
Experimental Procedures
11. Health Information Portability and Accountability Act
open panel HMO
crossover claim
referral
HIPAA
12. Someone who is eligible for or receiving benefits under an insurance policy or plan
complience plan
Deductible
ordering physician
Beneficiary
13. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Individually identifiable health information
self-referral
referring physician
14. 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
complience plan
Claim
Security Rule
referral
15. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Network
(ABN) Advance Beneficiary Notice
ee schedule
16. Health Information Portability and Accountability Act
HIPAA
prepaid plan
Open Enrollment
Deductible
17. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
privacy
ee schedule
epo
Pre-certification
18. 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
Individually identifiable health information
cash flow
authorization form
breach of confidential communication
19. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Preauthorization
confidentiality
(PCP) Primary Care Physician
business associate
20. 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
crossover claim
Individually identifiable health information
complience plan
pos
21. 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
Consent form
Covered Expenses
(OOPs) Out of Pocket Costs/Expenses
Deductible
22. Medicare's method of paying acute care hospitals for inpatient care
Specialist
premium
Sub-acute Care
(PPS) Hospital Impatient Prospective Payment System
23. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(POS) Point-of Service Plan
subscriber
(COBRA)
referral
24. Billing for services not performed
breach of confidential communication
Referral
subscriber
phantom billing
25. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
benefit period
disclosure
clearinghouse
deductible
26. Customs - rules of conduct - courtesy - and manners of the medical profession
HIPAA
econdary Payer
(DOS) Date of Service
etiquette
27. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
ordering physician
medical foundation
covered entity
28. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
attending physician
health care provider
econdary Payer
29. 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
(COBRA)
Pre-existing Condition Exclusion
30. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
transaction
(COBRA)
Notice of Privacy Practices
hmo
31. 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
(OOPs) Out of Pocket Costs/Expenses
(ERISA) Employee Retirement Income Security Act of 1974
Subscriber
Covered Expenses
32. Standards of conduct generally accepted as a moral guide for behavior.
(APC) Ambulatory Patient Classifications
(EPO) Exclusive Provider Organization
ethics
(DME) Durable Medical Equipment
33. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
ee schedule
electronic media
Deductible
Experimental Procedures
34. 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
(PPS) Hospital Impatient Prospective Payment System
(AOB) Assignment of Benefits
privacy
(ERISA) Employee Retirement Income Security Act of 1974
35. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(EPO) Exclusive Provider Organization
Individually identifiable health information
pos
Covered Expenses
36. 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
(ABN) Advance Beneficiary Notice
(ERISA) Employee Retirement Income Security Act of 1974
ids
econdary Payer
37. 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
covered entity
(TPA) Third Party Administrator
security officer
38. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
medical foundation
security officer
Participating Provider
39. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
econdary Payer
(PEC) Pre-existing condition
(AOB) Assignment of Benefits
Amblatory Care
40. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(OOPs) Out of Pocket Costs/Expenses
Confidential communication
e-health information management
confidentiality
41. Billing for services not performed
attending physician
(DRG's)
Coordinated Coverage
phantom billing
42. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals
Specialist
consulting physician
Supplementary Medical Insurance
(PAC) Pre- Admission Certification
43. 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.
(UCR) Usual - Customary and Reasonable
Protected health information
(PCP) Primary Care Physician
(UR) Utilization review
44. An organization of provider sites with a contracted relationship that offer services
Out of Network (OON)
ids
prepaid plan
Sub-acute Care
45. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
abuse
preauthorization
(EPO) Exclusive Provider Organization
open panel HMO
46. The transmission of information between two parties to carry out financial or administrative activities related to health care.
state preemption
clearinghouse
Supplementary Medical Insurance
transaction
47. Is the provider who renders a service to a patient
(COB) Coordination of Benefits
Treating or performing physician
Pre-certification
referral
48. A privileged communication that may be disclosed only with the patient's permission.
(DME) Durable Medical Equipment
Referral
(AOB) Assignment of Benefits
Confidential communication
49. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(UCR) Usual - Customary and Reasonable
Subscriber
(PPS) Hospital Impatient Prospective Payment System
abuse
50. A health insurance enrollee chooses to see an out of network provider without authorization
Security Rule
self-referral
(COBRA)
business associate