SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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 physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Confidential communication
IIHI
Consent form
Specialist
2. A review of the need for inpatient hospital care - completed before the actual admission
(DME) Durable Medical Equipment
Claim
Covered Expenses
(PAC) Pre- Admission Certification
3. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
4. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
ethics
pos
consulting physician
e-health information management
5. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
epo
state preemption
clearinghouse
Consent form
6. A patient claim is eligible for medicare and medicaid
security officer
Standard
crossover claim
(UR) Utilization review
7. 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
(UR) Utilization review
subscriber
complience
Experimental Procedures
8. An intentional misrepresentation of the facts to deceive or mislead another.
medical foundation
Pre-existing Condition Exclusion
fraud
deductible
9. A review of the need for inpatient hospital care - completed before the actual admission
(EPO) Exclusive Provider Organization
(PAC) Pre- Admission Certification
Experimental Procedures
Notice of Privacy Practices
10. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
epo
(DME) Durable Medical Equipment
premium
Network
11. 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
Confidential communication
Embezzlement
(OOPs) Out of Pocket Costs/Expenses
12. Individually identifiable health information
IIHI
Confidential communication
authorization form
fraud
13. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Beneficiary
abuse
(DOS) Date of Service
14. Health Information Portability and Accountability Act
clearinghouse
Privileged information
Specialist
HIPAA
15. 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
complience
Participating Provider
Network
16. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
ppo
(DCI) Duplicate Coverage Inquiry
(UCR) Usual - Customary and Reasonable
Embezzlement
17. 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
Deductible
(AOB) Assignment of Benefits
ee schedule
(UCR) Usual - Customary and Reasonable
18. Approval or consent by a primary physician for patient referral to ancillary services and specialists
security officer
electronic media
Preauthorization
Referral
19. Is a provider who sends the patients for testing or treatment
confidentiality
referring physician
Security Rule
cash flow
20. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
complience
electronic media
(PPS) Hospital Impatient Prospective Payment System
cash flow
21. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity
business associate
phantom billing
(ABN) Advance Beneficiary Notice
(OOPs) Out of Pocket Costs/Expenses
22. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(APC) Ambulatory Patient Classifications
fraud
Claim
(UR) Utilization review
23. Is the provider who renders a service to a patient
Amblatory Care
Treating or performing physician
ids
(POS) Point-of Service Plan
24. Standards of conduct generally accepted as a moral guide for behavior.
referral
ethics
medical foundation
Treating or performing physician
25. A clinic that is owned by the HMO and the physicians are employees of the HMO
referring physician
Referral
(PPS) Hospital Impatient Prospective Payment System
closed panel HMO
26. The maximum amount a plan pays for a covered service
Allowed Expenses
cash flow
Treating or performing physician
business associate
27. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PEC) Pre-existing condition
Deductible
complience
(TPA) Third Party Administrator
28. A list of the amount to be paid by an insurance company for each procedure service
phantom billing
ee schedule
clearinghouse
Covered Expenses
29. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(OOPs) Out of Pocket Costs/Expenses
Coordinated Coverage
Notice of Privacy Practices
e-health information management
30. 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
(PCP) Primary Care Physician
Subscriber
Out of Network (OON)
electronic media
31. 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
Supplementary Medical Insurance
confidentiality
subscriber
Deductible
32. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
abuse
preauthorization
(ABN) Advance Beneficiary Notice
Subscriber
33. 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
(ERISA) Employee Retirement Income Security Act of 1974
(PCN) Primary Care Network
deductible
consent
34. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Maximum Out Of Pocket
(DME) Durable Medical Equipment
self-referral
Pre-certification
35. 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
business associate
Individually identifiable health information
Allowed Expenses
36. 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
claim
referring physician
Sub-acute Care
econdary Payer
37. A privileged communication that may be disclosed only with the patient's permission.
Treating or performing physician
ids
state preemption
Confidential communication
38. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
consent
electronic media
(COB) Coordination of Benefits
39. A monthly fee paid by the insured for specific medical insurance coverage
(OOPs) Out of Pocket Costs/Expenses
(PCP) Primary Care Physician
premium
Out of Network (OON)
40. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
ethics
Maximum Out Of Pocket
ee schedule
41. 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
etiquette
Allowed Expenses
Amblatory Care
(COBRA)
42. 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
pos
cash flow
open panel HMO
benefit period
43. American Medical Association
AMA
complience plan
pos
Standard
44. Billing for services not performed
(DOS) Date of Service
(UR) Utilization review
phantom billing
Supplementary Medical Insurance
45. A clinic that is owned by the HMO and the physicians are employees of the HMO
ppo
closed panel HMO
Subscriber
complience
46. Unauthorized release of information
breach of confidential communication
(OOPs) Out of Pocket Costs/Expenses
cash flow
(DME) Durable Medical Equipment
47. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
Standard
Pre-certification
IIHI
48. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
complience
(PAC) Pre- Admission Certification
Deductible
49. 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.
(COBRA)
Allowed Expenses
Protected health information
benefit period
50. A rule - condition - or requirement
(DCI) Duplicate Coverage Inquiry
transaction
benefit period
Standard