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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. 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
pos
Preauthorization
etiquette
Maximum Out Of Pocket
2. Unauthorized release of information
self-referral
Assignment & Authorization
breach of confidential communication
Privacy officer
3. Health Information Portability and Accountability Act
Beneficiary
HIPAA
ee schedule
Pre-existing Condition Exclusion
4. The period of time that payment for Medicare inpatient hospital benefits are available
(DCI) Duplicate Coverage Inquiry
Standard
benefit period
referral
5. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
(PPS) Hospital Impatient Prospective Payment System
Supplementary Medical Insurance
benefit period
6. The amount of actual money available to the medical practice
(ABN) Advance Beneficiary Notice
Beneficiary
(UCR) Usual - Customary and Reasonable
cash flow
7. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
ppo
business associate
health care provider
8. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Privacy officer
(COBRA)
(TPA) Third Party Administrator
ids
9. 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.
Participating Provider
(PPS) Hospital Impatient Prospective Payment System
Protected health information
pcp
10. The dates of healthcare services were provided to the beneficiary
(UCR) Usual - Customary and Reasonable
(EPO) Exclusive Provider Organization
(DOS) Date of Service
(PPS) Hospital Impatient Prospective Payment System
11. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
nonprivileged information
epo
pos
confidentiality
12. Billing for services not performed
phantom billing
Resonable Charge
(UR) Utilization review
pos
13. Standards of conduct generally accepted as a moral guide for behavior.
ethics
Open Enrollment
(AOB) Assignment of Benefits
Medigap Insurance
14. A health insurance enrollee chooses to see an out of network provider without authorization
Preauthorization
self-referral
Protected health information
AMA
15. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
preauthorization
referring physician
covered entity
clearinghouse
16. An organization of provider sites with a contracted relationship that offer services
open panel HMO
(DRG's)
Privileged information
ids
17. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(PAC) Pre- Admission Certification
(POS) Point-of Service Plan
(UR) Utilization review
referring physician
18. 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
Treating or performing physician
Confidential communication
deductible
Sub-acute Care
19. 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
benefit period
Out of Network (OON)
(ABN) Advance Beneficiary Notice
consent
20. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
etiquette
(ERISA) Employee Retirement Income Security Act of 1974
Privileged information
21. 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
Resonable Charge
Experimental Procedures
self-referral
consulting physician
22. 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
pcp
(POS) Point-of Service Plan
Standard
(PCN) Primary Care Network
23. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(OOPs) Out of Pocket Costs/Expenses
Experimental Procedures
ppo
referral
24. 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
Pre-existing Condition Exclusion
complience
(PAC) Pre- Admission Certification
Supplementary Medical Insurance
25. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Confidential communication
Resonable Charge
privacy
(UCR) Usual - Customary and Reasonable
26. Unauthorized release of information
Allowed Expenses
covered entity
Privacy officer
breach of confidential communication
27. Integrating benefits payable under more than one health insurance.
Security Rule
Consent form
epo
Coordinated Coverage
28. 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
IIHI
(TPA) Third Party Administrator
benefit period
(COBRA)
29. A monthly fee paid by the insured for specific medical insurance coverage
Pre-certification
Individually identifiable health information
Participating Provider
premium
30. Standards of conduct generally accepted as a moral guide for behavior.
Network
Beneficiary
IIHI
ethics
31. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
hmo
preauthorization
(PAC) Pre- Admission Certification
confidentiality
32. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
medical foundation
self-referral
Resonable Charge
Pre-certification
33. A patient claim is eligible for medicare and medicaid
transaction
claim
crossover claim
subscriber
34. The period of time that payment for Medicare inpatient hospital benefits are available
Amblatory Care
Notice of Privacy Practices
benefit period
Coordinated Coverage
35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
IIHI
hmo
Participating Provider
(OOPs) Out of Pocket Costs/Expenses
36. 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
closed panel HMO
HIPAA
prepaid plan
disclosure
37. 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
(PEC) Pre-existing condition
etiquette
covered entity
Deductible
38. Is the provider who renders a service to a patient
Treating or performing physician
transaction
(DRG's)
prepaid plan
39. 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
(POS) Point-of Service Plan
authorization form
Assignment & Authorization
(DRG's)
40. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Sub-acute Care
referral
econdary Payer
41. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
cash flow
business associate
subscriber
crossover claim
42. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
(Non-par) Non-Participating Provider
Preauthorization
deductible
43. Medicare's method of paying acute care hospitals for inpatient care
Security Rule
(PCN) Primary Care Network
covered entity
(PPS) Hospital Impatient Prospective Payment System
44. 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
prepaid plan
Privacy officer
Resonable Charge
45. 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
authorization form
breach of confidential communication
econdary Payer
crossover claim
46. 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
referring physician
closed panel HMO
complience plan
47. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
Consent form
ids
pos
48. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
electronic media
clearinghouse
Beneficiary
claim
49. Is a provider who sends the patients for testing or treatment
Subscriber
Open Enrollment
referring physician
subscriber
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
Covered Expenses
subscriber
(PCN) Primary Care Network
Experimental Procedures