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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 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
fraud
econdary Payer
breach of confidential communication
Embezzlement
2. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
(DRG's)
(EPO) Exclusive Provider Organization
Security Rule
closed panel HMO
3. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Individually identifiable health information
breach of confidential communication
(DRG's)
4. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
deductible
Pre-certification
hmo
5. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
ids
state preemption
covered entity
(TPA) Third Party Administrator
6. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Coordinated Coverage
premium
Pre-certification
preauthorization
7. A willful act by an employee of taking possession of an employer's money
Embezzlement
pcp
Supplementary Medical Insurance
attending physician
8. The period of time that payment for Medicare inpatient hospital benefits are available
claim
Sub-acute Care
benefit period
subscriber
9. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
nonprivileged information
e-health information management
(EPO) Exclusive Provider Organization
Subscriber
10. 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
crossover claim
referral
AMA
Deductible
11. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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12. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
Claim
ee schedule
Experimental Procedures
13. 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
(PCP) Primary Care Physician
Privileged information
complience plan
14. 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)
clearinghouse
Consent form
Protected health information
pcp
15. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
prepaid plan
benefit period
IIHI
16. 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
IIHI
Covered Expenses
ordering physician
(ABN) Advance Beneficiary Notice
17. 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
complience
ee schedule
health care provider
(POS) Point-of Service Plan
18. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
fraud
Standard
prepaid plan
19. Billing for services not performed
referral
ee schedule
Coordinated Coverage
phantom billing
20. A monthly fee paid by the insured for specific medical insurance coverage
Pre-existing Condition Exclusion
IIHI
premium
medical foundation
21. Medicare's method of paying acute care hospitals for inpatient care
medical foundation
ethics
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
22. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Participating Provider
Specialist
benefit period
cash flow
23. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Consent form
Network
consent
breach of confidential communication
24. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(AOB) Assignment of Benefits
Pre-certification
consulting physician
covered entity
25. A privileged communication that may be disclosed only with the patient's permission.
Participating Provider
ordering physician
Confidential communication
preauthorization
26. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
state preemption
Privileged information
Experimental Procedures
disclosure
27. 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
Pre-existing Condition Exclusion
Sub-acute Care
referral
Medigap Insurance
28. Medical services provided on an outpatient basis
Confidential communication
Amblatory Care
(PCP) Primary Care Physician
IIHI
29. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
deductible
(ERISA) Employee Retirement Income Security Act of 1974
e-health information management
30. 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
Preauthorization
(TPA) Third Party Administrator
Supplementary Medical Insurance
Consent form
31. A nonprofit integrated delivery system
Medigap Insurance
referring physician
Sub-acute Care
medical foundation
32. Is the provider who renders a service to a patient
etiquette
breach of confidential communication
Treating or performing physician
nonprivileged information
33. Billing for services not performed
Referral
phantom billing
(PCN) Primary Care Network
(AOB) Assignment of Benefits
34. 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.
hmo
security officer
Individually identifiable health information
Protected health information
35. 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
(AOB) Assignment of Benefits
closed panel HMO
fraud
Deductible
36. 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
(DRG's)
Experimental Procedures
privacy
37. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(DME) Durable Medical Equipment
(UCR) Usual - Customary and Reasonable
preauthorization
Claim
38. Verbal or written agreement that gives approval to some action - situation - or statement.
breach of confidential communication
Resonable Charge
breach of confidential communication
consent
39. A review of the need for inpatient hospital care - completed before the actual admission
Beneficiary
Coordinated Coverage
(PAC) Pre- Admission Certification
premium
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
(PCP) Primary Care Physician
ppo
Pre-existing Condition Exclusion
(DOS) Date of Service
41. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DME) Durable Medical Equipment
abuse
complience
Medigap Insurance
42. 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.
Pre-certification
Referral
(TPA) Third Party Administrator
Privacy officer
43. 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.
Subscriber
HIPAA
Protected health information
(PEC) Pre-existing condition
44. 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
business associate
(PCN) Primary Care Network
(ABN) Advance Beneficiary Notice
state preemption
45. 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
cash flow
(ABN) Advance Beneficiary Notice
Individually identifiable health information
(DCI) Duplicate Coverage Inquiry
46. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Confidential communication
closed panel HMO
Subscriber
47. The amount of actual money available to the medical practice
Network
referring physician
Sub-acute Care
cash flow
48. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
(COBRA)
Network
referring physician
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.
(EPO) Exclusive Provider Organization
Protected health information
Preauthorization
Supplementary Medical Insurance
50. 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
(PAC) Pre- Admission Certification
(Non-par) Non-Participating Provider
complience plan
confidentiality
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