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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
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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. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
business associate
econdary Payer
AMA
Network
2. 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
Medigap Insurance
e-health information management
Preauthorization
(APC) Ambulatory Patient Classifications
3. 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
claim
(DME) Durable Medical Equipment
AMA
Covered Expenses
4. 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
Preauthorization
covered entity
Experimental Procedures
security officer
5. Unauthorized release of information
Beneficiary
referral
Treating or performing physician
breach of confidential communication
6. 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
crossover claim
Out of Network (OON)
Treating or performing physician
Consent form
7. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
claim
consulting physician
(COB) Coordination of Benefits
8. Billing for services not performed
phantom billing
Experimental Procedures
econdary Payer
prepaid plan
9. 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
(OOPs) Out of Pocket Costs/Expenses
prepaid plan
ethics
authorization form
10. Medicare's method of paying acute care hospitals for inpatient care
(Non-par) Non-Participating Provider
Embezzlement
(PPS) Hospital Impatient Prospective Payment System
Coordinated Coverage
11. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PCP) Primary Care Physician
complience
business associate
etiquette
12. The dates of healthcare services were provided to the beneficiary
transaction
referring physician
(DOS) Date of Service
Maximum Out Of Pocket
13. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
confidentiality
referral
Privileged information
Maximum Out Of Pocket
14. A patient claim is eligible for medicare and medicaid
crossover claim
complience plan
pcp
cash flow
15. 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
(UCR) Usual - Customary and Reasonable
prepaid plan
(Non-par) Non-Participating Provider
16. 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.
Sub-acute Care
breach of confidential communication
Specialist
Privacy officer
17. 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
pcp
(ERISA) Employee Retirement Income Security Act of 1974
e-health information management
(PCN) Primary Care Network
18. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Privacy officer
Network
security officer
19. 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.
(POS) Point-of Service Plan
confidentiality
health care provider
phantom billing
20. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Deductible
etiquette
(PPS) Hospital Impatient Prospective Payment System
21. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(PCN) Primary Care Network
(EPO) Exclusive Provider Organization
(PPS) Hospital Impatient Prospective Payment System
epo
22. 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.
benefit period
self-referral
Protected health information
hmo
23. Is the provider who renders a service to a patient
open panel HMO
Treating or performing physician
disclosure
ids
24. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
phantom billing
transaction
Privileged information
25. Is a provider who sends the patients for testing or treatment
Subscriber
health care provider
referring physician
ethics
26. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Referral
medical foundation
Allowed Expenses
27. 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
(PEC) Pre-existing condition
Maximum Out Of Pocket
deductible
complience
28. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
referring physician
(PEC) Pre-existing condition
(COBRA)
clearinghouse
29. The period of time that payment for Medicare inpatient hospital benefits are available
Preauthorization
Coordinated Coverage
(UCR) Usual - Customary and Reasonable
benefit period
30. 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
(PEC) Pre-existing condition
consent
Deductible
31. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
crossover claim
electronic media
covered entity
32. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Preauthorization
self-referral
Deductible
subscriber
33. 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
Medigap Insurance
fraud
Allowed Expenses
34. 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
(OOPs) Out of Pocket Costs/Expenses
abuse
Supplementary Medical Insurance
(PEC) Pre-existing condition
35. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
pos
Confidential communication
Notice of Privacy Practices
disclosure
36. A health insurance enrollee chooses to see an out of network provider without authorization
business associate
self-referral
open panel HMO
Claim
37. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
Specialist
phantom billing
deductible
38. American Medical Association
Confidential communication
prepaid plan
AMA
(PPS) Hospital Impatient Prospective Payment System
39. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Network
AMA
Participating Provider
complience plan
40. 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
(OOPs) Out of Pocket Costs/Expenses
Maximum Out Of Pocket
(DRG's)
(PEC) Pre-existing condition
41. Is the provider who renders a service to a patient
Treating or performing physician
pos
(EPO) Exclusive Provider Organization
(PCP) Primary Care Physician
42. A provision that apples when a person is covered under more than one group medical program
complience
(COB) Coordination of Benefits
clearinghouse
Privacy officer
43. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Security Rule
claim
referral
(AOB) Assignment of Benefits
44. 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
etiquette
authorization form
(DRG's)
ee schedule
45. Standards of conduct generally accepted as a moral guide for behavior.
Treating or performing physician
ethics
transaction
business associate
46. 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
Experimental Procedures
(ERISA) Employee Retirement Income Security Act of 1974
Amblatory Care
Coordinated Coverage
47. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
open panel HMO
state preemption
hmo
48. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
ids
(Non-par) Non-Participating Provider
complience plan
(OOPs) Out of Pocket Costs/Expenses
49. 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.
subscriber
Notice of Privacy Practices
transaction
Experimental Procedures
50. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
(AOB) Assignment of Benefits
confidentiality
preauthorization