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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 sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(Non-par) Non-Participating Provider
Pre-existing Condition Exclusion
Specialist
2. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
(AOB) Assignment of Benefits
premium
(DCI) Duplicate Coverage Inquiry
3. A willful act by an employee of taking possession of an employer's money
Embezzlement
Experimental Procedures
transaction
self-referral
4. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
premium
Individually identifiable health information
(DOS) Date of Service
(PCP) Primary Care Physician
5. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
Referral
(PCN) Primary Care Network
abuse
Open Enrollment
6. 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
Deductible
complience plan
Pre-existing Condition Exclusion
e-health information management
7. The dates of healthcare services were provided to the beneficiary
crossover claim
(DOS) Date of Service
cash flow
ids
8. 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
deductible
open panel HMO
econdary Payer
(DCI) Duplicate Coverage Inquiry
9. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
prepaid plan
Experimental Procedures
(OOPs) Out of Pocket Costs/Expenses
Open Enrollment
10. 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.
Notice of Privacy Practices
HIPAA
transaction
Network
11. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
Consent form
(PCN) Primary Care Network
(EPO) Exclusive Provider Organization
12. Health Information Portability and Accountability Act
Coordinated Coverage
HIPAA
Coordinated Coverage
pos
13. 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
prepaid plan
Maximum Out Of Pocket
consulting physician
Beneficiary
14. 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
(ERISA) Employee Retirement Income Security Act of 1974
(COBRA)
self-referral
Claim
15. Someone who is eligible for or receiving benefits under an insurance policy or plan
ee schedule
Referral
econdary Payer
Beneficiary
16. The period of time that payment for Medicare inpatient hospital benefits are available
health care provider
complience
benefit period
complience plan
17. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
pcp
Maximum Out Of Pocket
(POS) Point-of Service Plan
referral
18. A monthly fee paid by the insured for specific medical insurance coverage
claim
premium
security officer
Embezzlement
19. 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
state preemption
self-referral
open panel HMO
breach of confidential communication
20. American Medical Association
(Non-par) Non-Participating Provider
AMA
ppo
Open Enrollment
21. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
premium
state preemption
crossover claim
Network
22. A monthly fee paid by the insured for specific medical insurance coverage
Embezzlement
authorization form
consulting physician
premium
23. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Referral
attending physician
disclosure
(DRG's)
24. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
authorization form
(DOS) Date of Service
Covered Expenses
25. A rule - condition - or requirement
(OOPs) Out of Pocket Costs/Expenses
(DOS) Date of Service
Standard
premium
26. 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
pos
HIPAA
(OOPs) Out of Pocket Costs/Expenses
authorization form
27. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(UR) Utilization review
Claim
(PEC) Pre-existing condition
Privacy officer
28. Medicare's method of paying acute care hospitals for inpatient care
claim
(PPS) Hospital Impatient Prospective Payment System
(APC) Ambulatory Patient Classifications
(OOPs) Out of Pocket Costs/Expenses
29. 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
abuse
ethics
Supplementary Medical Insurance
benefit period
30. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
ee schedule
(PPS) Hospital Impatient Prospective Payment System
abuse
Experimental Procedures
31. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
(ABN) Advance Beneficiary Notice
complience
open panel HMO
32. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
medical foundation
privacy
abuse
ppo
33. 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.
Notice of Privacy Practices
Protected health information
phantom billing
prepaid plan
34. 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
etiquette
(ERISA) Employee Retirement Income Security Act of 1974
Out of Network (OON)
prepaid plan
35. Individually identifiable health information
security officer
IIHI
crossover claim
open panel HMO
36. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(POS) Point-of Service Plan
(EPO) Exclusive Provider Organization
complience plan
ordering physician
37. 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.
(UR) Utilization review
abuse
Privacy officer
(EPO) Exclusive Provider Organization
38. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Allowed Expenses
ethics
Deductible
(PEC) Pre-existing condition
39. Customs - rules of conduct - courtesy - and manners of the medical profession
Amblatory Care
etiquette
Confidential communication
(Non-par) Non-Participating Provider
40. 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
Claim
Participating Provider
Pre-existing Condition Exclusion
(PCN) Primary Care Network
41. The transmission of information between two parties to carry out financial or administrative activities related to health care.
complience
transaction
Open Enrollment
Individually identifiable health information
42. 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.
security officer
(PEC) Pre-existing condition
Privileged information
Open Enrollment
43. Is the provider who renders a service to a patient
(COB) Coordination of Benefits
transaction
Beneficiary
Treating or performing physician
44. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
referral
Claim
(DCI) Duplicate Coverage Inquiry
(EPO) Exclusive Provider Organization
45. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Specialist
Subscriber
(POS) Point-of Service Plan
Deductible
46. 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.
state preemption
pcp
Network
covered entity
47. 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
(ABN) Advance Beneficiary Notice
pcp
security officer
referring physician
48. A list of the amount to be paid by an insurance company for each procedure service
(DME) Durable Medical Equipment
ee schedule
ppo
ordering physician
49. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Pre-existing Condition Exclusion
pcp
Claim
(ERISA) Employee Retirement Income Security Act of 1974
50. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
AMA
(COB) Coordination of Benefits
covered entity
preauthorization