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. 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
(COB) Coordination of Benefits
(COB) Coordination of Benefits
Allowed Expenses
(ABN) Advance Beneficiary Notice
2. What the insurance company will consider paying for as defined in the contract.
Standard
Referral
complience plan
Covered Expenses
3. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Covered Expenses
hmo
Medigap Insurance
AMA
4. A clinic that is owned by the HMO and the physicians are employees of the HMO
Referral
closed panel HMO
(UR) Utilization review
(DOS) Date of Service
5. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Covered Expenses
disclosure
clearinghouse
Pre-certification
6. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
confidentiality
epo
Out of Network (OON)
complience plan
7. A patient claim is eligible for medicare and medicaid
Assignment & Authorization
Coordinated Coverage
Beneficiary
crossover claim
8. 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
(PCN) Primary Care Network
Treating or performing physician
(DRG's)
Participating Provider
9. Someone who is eligible for or receiving benefits under an insurance policy or plan
attending physician
Embezzlement
Beneficiary
referring physician
10. 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
Standard
complience plan
IIHI
Maximum Out Of Pocket
11. 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
(DME) Durable Medical Equipment
Network
(PCN) Primary Care Network
Amblatory Care
12. 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.
(PCN) Primary Care Network
security officer
attending physician
epo
13. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Confidential communication
(UR) Utilization review
Notice of Privacy Practices
Pre-certification
14. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(DRG's)
clearinghouse
complience plan
Claim
15. 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
Specialist
Pre-existing Condition Exclusion
(APC) Ambulatory Patient Classifications
privacy
16. Standards of conduct generally accepted as a moral guide for behavior.
ethics
premium
Subscriber
Covered Expenses
17. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Preauthorization
(DRG's)
econdary Payer
claim
18. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(PCN) Primary Care Network
Individually identifiable health information
phantom billing
referral
19. Is a provider who sends the patients for testing or treatment
benefit period
Deductible
referring physician
ee schedule
20. Unauthorized release of information
(COB) Coordination of Benefits
breach of confidential communication
Resonable Charge
fraud
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
(ABN) Advance Beneficiary Notice
Experimental Procedures
Network
econdary Payer
22. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Maximum Out Of Pocket
deductible
Referral
(PPS) Hospital Impatient Prospective Payment System
23. 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
phantom billing
ids
Experimental Procedures
pos
24. The maximum amount a plan pays for a covered service
Allowed Expenses
disclosure
Open Enrollment
complience
25. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Treating or performing physician
Maximum Out Of Pocket
subscriber
security officer
26. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare
covered entity
electronic media
abuse
(Non-par) Non-Participating Provider
27. 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
Standard
Pre-certification
econdary Payer
(POS) Point-of Service Plan
28. 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
(TPA) Third Party Administrator
(AOB) Assignment of Benefits
Privacy officer
preauthorization
29. Unauthorized release of information
business associate
Sub-acute Care
breach of confidential communication
closed panel HMO
30. A privileged communication that may be disclosed only with the patient's permission.
Maximum Out Of Pocket
(POS) Point-of Service Plan
Confidential communication
closed panel HMO
31. 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.
Privileged information
etiquette
(DRG's)
(POS) Point-of Service Plan
32. A provision that apples when a person is covered under more than one group medical program
Participating Provider
(COB) Coordination of Benefits
(POS) Point-of Service Plan
Beneficiary
33. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(PPS) Hospital Impatient Prospective Payment System
(UR) Utilization review
open panel HMO
authorization form
34. 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
Supplementary Medical Insurance
confidentiality
electronic media
35. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
nonprivileged information
Embezzlement
Treating or performing physician
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
security officer
Allowed Expenses
Sub-acute Care
Notice of Privacy Practices
37. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
Warning
: Invalid argument supplied for foreach() in
/var/www/html/basicversity.com/show_quiz.php
on line
183
38. 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.
open panel HMO
cash flow
health care provider
Pre-certification
39. The dates of healthcare services were provided to the beneficiary
Preauthorization
IIHI
(DOS) Date of Service
breach of confidential communication
40. 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
breach of confidential communication
Coordinated Coverage
crossover claim
Participating Provider
41. A nonprofit integrated delivery system
Coordinated Coverage
Experimental Procedures
consent
medical foundation
42. Customs - rules of conduct - courtesy - and manners of the medical profession
ee schedule
Pre-existing Condition Exclusion
referring physician
etiquette
43. American Medical Association
AMA
(COBRA)
deductible
(UR) Utilization review
44. What the insurance company will consider paying for as defined in the contract.
(POS) Point-of Service Plan
Covered Expenses
Amblatory Care
authorization form
45. A health insurance enrollee chooses to see an out of network provider without authorization
HIPAA
Claim
self-referral
crossover claim
46. 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
(PPS) Hospital Impatient Prospective Payment System
privacy
complience plan
(POS) Point-of Service Plan
47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
closed panel HMO
pcp
AMA
complience plan
48. 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.
benefit period
state preemption
Open Enrollment
(DRG's)
49. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Experimental Procedures
(EPO) Exclusive Provider Organization
Referral
(OOPs) Out of Pocket Costs/Expenses
50. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Maximum Out Of Pocket
(PEC) Pre-existing condition
(DME) Durable Medical Equipment
Subscriber