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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. 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.
Protected health information
deductible
business associate
(DOS) Date of Service
2. Medical services provided on an outpatient basis
claim
health care provider
Amblatory Care
Embezzlement
3. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Security Rule
confidentiality
(DOS) Date of Service
disclosure
4. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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5. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
referring physician
closed panel HMO
e-health information management
claim
6. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PAC) Pre- Admission Certification
etiquette
transaction
privacy
7. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
HIPAA
subscriber
AMA
8. 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
Embezzlement
Network
closed panel HMO
9. Customs - rules of conduct - courtesy - and manners of the medical profession
Specialist
Embezzlement
(OOPs) Out of Pocket Costs/Expenses
etiquette
10. The amount of actual money available to the medical practice
Protected health information
Security Rule
cash flow
(DME) Durable Medical Equipment
11. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
disclosure
Subscriber
premium
12. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Confidential communication
Participating Provider
closed panel HMO
Individually identifiable health information
13. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
Pre-existing Condition Exclusion
ethics
AMA
(UCR) Usual - Customary and Reasonable
14. 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
nonprivileged information
Assignment & Authorization
etiquette
Maximum Out Of Pocket
15. 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
abuse
fraud
Security Rule
ppo
16. An organization of provider sites with a contracted relationship that offer services
Subscriber
ids
(PAC) Pre- Admission Certification
(COB) Coordination of Benefits
17. Billing for services not performed
(PAC) Pre- Admission Certification
covered entity
phantom billing
disclosure
18. 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.
Medigap Insurance
Sub-acute Care
Privacy officer
covered entity
19. 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
Supplementary Medical Insurance
(POS) Point-of Service Plan
state preemption
Assignment & Authorization
20. 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.
Referral
Amblatory Care
Privileged information
Notice of Privacy Practices
21. 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.
business associate
(PPS) Hospital Impatient Prospective Payment System
Pre-existing Condition Exclusion
health care provider
22. Standards of conduct generally accepted as a moral guide for behavior.
state preemption
ethics
complience
Covered Expenses
23. 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
privacy
HIPAA
complience
econdary Payer
24. The dates of healthcare services were provided to the beneficiary
Subscriber
(DOS) Date of Service
phantom billing
nonprivileged information
25. An organization of provider sites with a contracted relationship that offer services
Supplementary Medical Insurance
ids
consulting physician
health care provider
26. 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
nonprivileged information
Individually identifiable health information
crossover claim
27. 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
crossover claim
Preauthorization
Individually identifiable health information
Privileged information
28. 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
Notice of Privacy Practices
Supplementary Medical Insurance
self-referral
(UCR) Usual - Customary and Reasonable
29. 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
Participating Provider
(AOB) Assignment of Benefits
Medigap Insurance
(DOS) Date of Service
30. 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
Beneficiary
(PAC) Pre- Admission Certification
prepaid plan
closed panel HMO
31. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
pos
Medigap Insurance
benefit period
etiquette
32. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Deductible
security officer
phantom billing
33. American Medical Association
Participating Provider
econdary Payer
AMA
Coordinated Coverage
34. The condition of being secluded from the presence or view of others.
privacy
state preemption
nonprivileged information
Medigap Insurance
35. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Supplementary Medical Insurance
ordering physician
Specialist
(POS) Point-of Service Plan
36. 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)
ppo
self-referral
preauthorization
37. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Security Rule
Medigap Insurance
(ERISA) Employee Retirement Income Security Act of 1974
38. 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
privacy
(APC) Ambulatory Patient Classifications
consulting physician
(DME) Durable Medical Equipment
39. 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
Privacy officer
Allowed Expenses
econdary Payer
authorization form
40. 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
ppo
Out of Network (OON)
Beneficiary
open panel HMO
41. A health insurance enrollee chooses to see an out of network provider without authorization
(Non-par) Non-Participating Provider
Deductible
self-referral
Out of Network (OON)
42. 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
Treating or performing physician
pos
Out of Network (OON)
abuse
43. 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
fraud
(PAC) Pre- Admission Certification
Pre-existing Condition Exclusion
Sub-acute Care
44. Medicare's method of paying acute care hospitals for inpatient care
fraud
Privileged information
(PPS) Hospital Impatient Prospective Payment System
(POS) Point-of Service Plan
45. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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46. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(APC) Ambulatory Patient Classifications
preauthorization
Assignment & Authorization
Out of Network (OON)
47. Is the provider who renders a service to a patient
(TPA) Third Party Administrator
Treating or performing physician
(PAC) Pre- Admission Certification
(DOS) Date of Service
48. 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
(PCN) Primary Care Network
Deductible
(AOB) Assignment of Benefits
Assignment & Authorization
49. 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
cash flow
state preemption
attending physician
50. 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.
Covered Expenses
Protected health information
security officer
referral