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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. An intentional misrepresentation of the facts to deceive or mislead another.
(PAC) Pre- Admission Certification
ordering physician
IIHI
fraud
2. 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
business associate
prepaid plan
disclosure
3. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Specialist
ee schedule
Network
4. Is the provider who renders a service to a patient
Treating or performing physician
(POS) Point-of Service Plan
Maximum Out Of Pocket
Participating Provider
5. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Experimental Procedures
(ABN) Advance Beneficiary Notice
privacy
6. 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
Pre-certification
AMA
Pre-existing Condition Exclusion
7. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
(PPS) Hospital Impatient Prospective Payment System
nonprivileged information
Assignment & Authorization
HIPAA
8. 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
(ERISA) Employee Retirement Income Security Act of 1974
Sub-acute Care
(DME) Durable Medical Equipment
epo
9. What the insurance company will consider paying for as defined in the contract.
subscriber
Allowed Expenses
Covered Expenses
complience plan
10. 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
Open Enrollment
(ERISA) Employee Retirement Income Security Act of 1974
Referral
(DRG's)
11. A patient claim is eligible for medicare and medicaid
crossover claim
ethics
Resonable Charge
disclosure
12. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Sub-acute Care
phantom billing
ee schedule
(DCI) Duplicate Coverage Inquiry
13. 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.
Experimental Procedures
deductible
(UR) Utilization review
Protected health information
14. Unauthorized release of information
authorization form
crossover claim
breach of confidential communication
Consent form
15. An organization of provider sites with a contracted relationship that offer services
consent
Maximum Out Of Pocket
security officer
ids
16. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
17. Approval or consent by a primary physician for patient referral to ancillary services and specialists
authorization form
disclosure
Referral
Deductible
18. 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
closed panel HMO
Security Rule
Privacy officer
(PCN) Primary Care Network
19. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Sub-acute Care
Allowed Expenses
abuse
premium
20. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
claim
Resonable Charge
Network
Experimental Procedures
21. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(DOS) Date of Service
prepaid plan
(EPO) Exclusive Provider Organization
22. 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
Out of Network (OON)
Standard
(POS) Point-of Service Plan
Privileged information
23. 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
Privacy officer
confidentiality
Maximum Out Of Pocket
(PEC) Pre-existing condition
24. 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.
subscriber
(UCR) Usual - Customary and Reasonable
health care provider
Out of Network (OON)
25. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Standard
(DME) Durable Medical Equipment
Consent form
26. 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
consent
(AOB) Assignment of Benefits
etiquette
preauthorization
27. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Subscriber
Referral
ordering physician
28. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Supplementary Medical Insurance
state preemption
Referral
privacy
29. Is a provider who sends the patients for testing or treatment
benefit period
cash flow
subscriber
referring physician
30. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
deductible
(POS) Point-of Service Plan
Specialist
31. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Allowed Expenses
Consent form
medical foundation
32. Verbal or written agreement that gives approval to some action - situation - or statement.
crossover claim
Subscriber
consent
prepaid plan
33. Health Information Portability and Accountability Act
etiquette
state preemption
HIPAA
Confidential communication
34. 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
Out of Network (OON)
Maximum Out Of Pocket
claim
Individually identifiable health information
35. 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
(Non-par) Non-Participating Provider
e-health information management
(COB) Coordination of Benefits
(POS) Point-of Service Plan
36. 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
Specialist
Assignment & Authorization
nonprivileged information
abuse
37. A rule - condition - or requirement
Resonable Charge
Standard
(EPO) Exclusive Provider Organization
Preauthorization
38. Individually identifiable health information
Assignment & Authorization
e-health information management
IIHI
covered entity
39. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Beneficiary
(COBRA)
Covered Expenses
40. A monthly fee paid by the insured for specific medical insurance coverage
premium
(DME) Durable Medical Equipment
Individually identifiable health information
ethics
41. What the insurance company will consider paying for as defined in the contract.
Preauthorization
e-health information management
Covered Expenses
(EPO) Exclusive Provider Organization
42. 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)
econdary Payer
IIHI
Consent form
e-health information management
43. 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
(AOB) Assignment of Benefits
premium
ordering physician
closed panel HMO
44. The condition of being secluded from the presence or view of others.
confidentiality
(DRG's)
(PAC) Pre- Admission Certification
privacy
45. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Standard
ppo
self-referral
46. 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
nonprivileged information
(UR) Utilization review
privacy
Preauthorization
47. A review of the need for inpatient hospital care - completed before the actual admission
Notice of Privacy Practices
Covered Expenses
fraud
(PAC) Pre- Admission Certification
48. A rule - condition - or requirement
consulting physician
Out of Network (OON)
Standard
Resonable Charge
49. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
IIHI
econdary Payer
Security Rule
pcp
50. 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
AMA
(ABN) Advance Beneficiary Notice
claim
(PCN) Primary Care Network