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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. 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
(DOS) Date of Service
hmo
epo
Pre-existing Condition Exclusion
2. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(POS) Point-of Service Plan
(ERISA) Employee Retirement Income Security Act of 1974
pcp
claim
3. A willful act by an employee of taking possession of an employer's money
Resonable Charge
crossover claim
clearinghouse
Embezzlement
4. 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
Assignment & Authorization
ordering physician
pos
AMA
5. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
state preemption
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
claim
6. 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
(POS) Point-of Service Plan
Supplementary Medical Insurance
(DOS) Date of Service
e-health information management
7. 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
electronic media
econdary Payer
Deductible
subscriber
8. 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
(COB) Coordination of Benefits
Coordinated Coverage
Security Rule
Deductible
9. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Participating Provider
subscriber
confidentiality
nonprivileged information
10. 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
health care provider
(UR) Utilization review
Allowed Expenses
(COBRA)
11. 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.
Privacy officer
(TPA) Third Party Administrator
nonprivileged information
IIHI
12. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
covered entity
deductible
privacy
ethics
13. The condition of being secluded from the presence or view of others.
referring physician
privacy
security officer
consent
14. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(DOS) Date of Service
electronic media
Covered Expenses
transaction
15. 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
Resonable Charge
nonprivileged information
Confidential communication
(COB) Coordination of Benefits
16. A clinic that is owned by the HMO and the physicians are employees of the HMO
ids
Referral
complience plan
closed panel HMO
17. 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
(DOS) Date of Service
(Non-par) Non-Participating Provider
epo
(UR) Utilization review
18. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Preauthorization
security officer
epo
Subscriber
19. 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
epo
deductible
(ERISA) Employee Retirement Income Security Act of 1974
Coordinated Coverage
20. 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
Individually identifiable health information
breach of confidential communication
(PCN) Primary Care Network
clearinghouse
21. 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)
pos
Consent form
open panel HMO
Open Enrollment
22. A health insurance enrollee chooses to see an out of network provider without authorization
Covered Expenses
self-referral
crossover claim
(OOPs) Out of Pocket Costs/Expenses
23. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(TPA) Third Party Administrator
(DRG's)
deductible
claim
24. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(PAC) Pre- Admission Certification
(APC) Ambulatory Patient Classifications
hmo
confidentiality
25. 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.
Privacy officer
hmo
(PAC) Pre- Admission Certification
clearinghouse
26. A provision that apples when a person is covered under more than one group medical program
subscriber
Supplementary Medical Insurance
Covered Expenses
(COB) Coordination of Benefits
27. 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
AMA
referral
(DCI) Duplicate Coverage Inquiry
28. 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.
Open Enrollment
Notice of Privacy Practices
HIPAA
privacy
29. An intentional misrepresentation of the facts to deceive or mislead another.
cash flow
Out of Network (OON)
benefit period
fraud
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
prepaid plan
hmo
(OOPs) Out of Pocket Costs/Expenses
Preauthorization
31. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Pre-certification
econdary Payer
(ABN) Advance Beneficiary Notice
32. Standards of conduct generally accepted as a moral guide for behavior.
state preemption
Privileged information
Sub-acute Care
ethics
33. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Individually identifiable health information
(TPA) Third Party Administrator
Amblatory Care
fraud
34. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
ee schedule
Individually identifiable health information
Subscriber
Notice of Privacy Practices
35. 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
Subscriber
Specialist
Confidential communication
36. Someone who is eligible for or receiving benefits under an insurance policy or plan
open panel HMO
referral
Beneficiary
Claim
37. An organization of provider sites with a contracted relationship that offer services
(COB) Coordination of Benefits
ids
Medigap Insurance
Pre-existing Condition Exclusion
38. 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.
Supplementary Medical Insurance
Notice of Privacy Practices
Sub-acute Care
econdary Payer
39. A list of the amount to be paid by an insurance company for each procedure service
Standard
open panel HMO
ee schedule
Protected health information
40. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Assignment & Authorization
Referral
(OOPs) Out of Pocket Costs/Expenses
Protected health information
41. Is a provider who sends the patients for testing or treatment
AMA
security officer
referring physician
Resonable Charge
42. 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
Supplementary Medical Insurance
referral
(ERISA) Employee Retirement Income Security Act of 1974
43. A review of the need for inpatient hospital care - completed before the actual admission
Pre-existing Condition Exclusion
Maximum Out Of Pocket
(COB) Coordination of Benefits
(PAC) Pre- Admission Certification
44. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
hmo
(PEC) Pre-existing condition
Individually identifiable health information
(UR) Utilization review
45. A monthly fee paid by the insured for specific medical insurance coverage
referring physician
premium
Security Rule
confidentiality
46. 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
fraud
(PCP) Primary Care Physician
subscriber
pos
47. A list of the amount to be paid by an insurance company for each procedure service
cash flow
ee schedule
pos
Pre-certification
48. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Security Rule
ppo
security officer
49. The period of time that payment for Medicare inpatient hospital benefits are available
(ABN) Advance Beneficiary Notice
benefit period
covered entity
ppo
50. 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.
Standard
complience plan
Pre-existing Condition Exclusion
Protected health information