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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. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
Claim
(POS) Point-of Service Plan
complience
Security Rule
2. An organization of provider sites with a contracted relationship that offer services
breach of confidential communication
cash flow
Security Rule
ids
3. Unauthorized release of information
(OOPs) Out of Pocket Costs/Expenses
Amblatory Care
econdary Payer
breach of confidential communication
4. Medical services provided on an outpatient basis
Deductible
Amblatory Care
complience
econdary Payer
5. A monthly fee paid by the insured for specific medical insurance coverage
Resonable Charge
premium
econdary Payer
prepaid plan
6. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Out of Network (OON)
benefit period
Medigap Insurance
(DRG's)
7. The amount of actual money available to the medical practice
Beneficiary
econdary Payer
(PEC) Pre-existing condition
cash flow
8. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(PAC) Pre- Admission Certification
transaction
consulting physician
9. A provision that apples when a person is covered under more than one group medical program
business associate
Resonable Charge
fraud
(COB) Coordination of Benefits
10. 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
Maximum Out Of Pocket
Open Enrollment
open panel HMO
ee schedule
11. An intentional misrepresentation of the facts to deceive or mislead another.
(OOPs) Out of Pocket Costs/Expenses
Privacy officer
fraud
Pre-certification
12. 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.
(PPS) Hospital Impatient Prospective Payment System
health care provider
Notice of Privacy Practices
(PCP) Primary Care Physician
13. 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
Security Rule
Out of Network (OON)
ids
Confidential communication
14. 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.
Referral
security officer
Open Enrollment
(Non-par) Non-Participating Provider
15. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Resonable Charge
(UCR) Usual - Customary and Reasonable
(DRG's)
preauthorization
16. An organization of provider sites with a contracted relationship that offer services
ids
preauthorization
ordering physician
(DRG's)
17. Individually identifiable health information
medical foundation
IIHI
Security Rule
AMA
18. 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
self-referral
preauthorization
Security Rule
prepaid plan
19. Medicare's method of paying acute care hospitals for inpatient care
nonprivileged information
authorization form
(PPS) Hospital Impatient Prospective Payment System
(OOPs) Out of Pocket Costs/Expenses
20. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
fraud
preauthorization
ee schedule
ethics
21. 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
(DCI) Duplicate Coverage Inquiry
Notice of Privacy Practices
AMA
epo
22. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(OOPs) Out of Pocket Costs/Expenses
Assignment & Authorization
electronic media
23. 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.
complience
clearinghouse
Protected health information
premium
24. A privileged communication that may be disclosed only with the patient's permission.
cash flow
Confidential communication
Preauthorization
Pre-existing Condition Exclusion
25. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
(UR) Utilization review
Notice of Privacy Practices
benefit period
26. 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
(POS) Point-of Service Plan
authorization form
open panel HMO
(DRG's)
27. Individually identifiable health information
consent
complience
IIHI
cash flow
28. A patient claim is eligible for medicare and medicaid
Assignment & Authorization
AMA
authorization form
crossover claim
29. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
(DCI) Duplicate Coverage Inquiry
(PCP) Primary Care Physician
etiquette
30. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
deductible
(UR) Utilization review
abuse
AMA
31. Someone who is eligible for or receiving benefits under an insurance policy or plan
(DRG's)
ids
Claim
Beneficiary
32. The maximum amount a plan pays for a covered service
Allowed Expenses
attending physician
AMA
(POS) Point-of Service Plan
33. The dates of healthcare services were provided to the beneficiary
business associate
self-referral
open panel HMO
(DOS) Date of Service
34. A review of the need for inpatient hospital care - completed before the actual admission
Treating or performing physician
Protected health information
(PAC) Pre- Admission Certification
consent
35. Customs - rules of conduct - courtesy - and manners of the medical profession
Participating Provider
etiquette
Notice of Privacy Practices
Security Rule
36. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Preauthorization
nonprivileged information
(PCP) Primary Care Physician
Network
37. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Covered Expenses
Referral
hmo
38. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
Pre-certification
(DME) Durable Medical Equipment
(APC) Ambulatory Patient Classifications
39. Approval or consent by a primary physician for patient referral to ancillary services and specialists
complience
Standard
Referral
state preemption
40. 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
(UR) Utilization review
Supplementary Medical Insurance
pos
(ERISA) Employee Retirement Income Security Act of 1974
41. 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.
(AOB) Assignment of Benefits
Notice of Privacy Practices
etiquette
medical foundation
42. A willful act by an employee of taking possession of an employer's money
consent
Embezzlement
(AOB) Assignment of Benefits
Protected health information
43. 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
open panel HMO
Resonable Charge
Treating or performing physician
e-health information management
44. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(PAC) Pre- Admission Certification
IIHI
privacy
(DCI) Duplicate Coverage Inquiry
45. A rule - condition - or requirement
claim
Standard
Pre-existing Condition Exclusion
Beneficiary
46. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
confidentiality
Notice of Privacy Practices
ethics
47. 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
Pre-certification
business associate
ordering physician
48. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
Security Rule
(APC) Ambulatory Patient Classifications
security officer
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
Sub-acute Care
referring physician
Subscriber
Out of Network (OON)
50. 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
open panel HMO
(TPA) Third Party Administrator
(EPO) Exclusive Provider Organization
Experimental Procedures
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