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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.
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. Health Information Portability and Accountability Act
closed panel HMO
Experimental Procedures
(DCI) Duplicate Coverage Inquiry
HIPAA
2. 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
Participating Provider
complience
confidentiality
crossover claim
3. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
premium
Notice of Privacy Practices
Specialist
confidentiality
4. A nonprofit integrated delivery system
claim
ee schedule
medical foundation
clearinghouse
5. 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
consulting physician
Assignment & Authorization
Beneficiary
Out of Network (OON)
6. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
disclosure
claim
state preemption
Treating or performing physician
7. A patient claim is eligible for medicare and medicaid
crossover claim
Deductible
consulting physician
subscriber
8. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Maximum Out Of Pocket
(PCN) Primary Care Network
Claim
9. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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10. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(ERISA) Employee Retirement Income Security Act of 1974
state preemption
Pre-certification
claim
11. The amount of actual money available to the medical practice
(UCR) Usual - Customary and Reasonable
cash flow
claim
attending physician
12. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Individually identifiable health information
(AOB) Assignment of Benefits
medical foundation
deductible
13. 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.
security officer
pcp
business associate
privacy
14. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
ee schedule
attending physician
Open Enrollment
15. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
consent
(UCR) Usual - Customary and Reasonable
Specialist
(POS) Point-of Service Plan
16. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
prepaid plan
Assignment & Authorization
consulting physician
ee schedule
17. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
security officer
prepaid plan
business associate
Claim
18. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Sub-acute Care
complience plan
Amblatory Care
19. Standards of conduct generally accepted as a moral guide for behavior.
(DRG's)
Individually identifiable health information
ethics
Privacy officer
20. 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
disclosure
Out of Network (OON)
(PCP) Primary Care Physician
(POS) Point-of Service Plan
21. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Specialist
e-health information management
breach of confidential communication
benefit period
22. 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
covered entity
(DCI) Duplicate Coverage Inquiry
ppo
Treating or performing physician
23. Medical services provided on an outpatient basis
Assignment & Authorization
open panel HMO
Amblatory Care
referral
24. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
ppo
(OOPs) Out of Pocket Costs/Expenses
e-health information management
electronic media
25. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Subscriber
(UCR) Usual - Customary and Reasonable
Protected health information
complience plan
26. Medical services provided on an outpatient basis
Amblatory Care
Allowed Expenses
security officer
self-referral
27. 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.
health care provider
fraud
pos
Claim
28. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
ethics
(PCN) Primary Care Network
premium
29. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations
deductible
fraud
covered entity
authorization form
30. 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
Privacy officer
(Non-par) Non-Participating Provider
Consent form
health care provider
31. 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
Treating or performing physician
Preauthorization
AMA
privacy
32. 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.
Protected health information
Participating Provider
Specialist
(DRG's)
33. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
ethics
consulting physician
(UR) Utilization review
(PCP) Primary Care Physician
34. 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
Specialist
Coordinated Coverage
business associate
Experimental Procedures
35. An organization of provider sites with a contracted relationship that offer services
health care provider
Sub-acute Care
ids
health care provider
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.
closed panel HMO
Participating Provider
Privileged information
cash flow
37. Medical staff member who is legally responsible for the care and treatment given to a patient.
cash flow
nonprivileged information
attending physician
(PAC) Pre- Admission Certification
38. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Deductible
Maximum Out Of Pocket
Security Rule
Pre-certification
39. A rule - condition - or requirement
Standard
(PAC) Pre- Admission Certification
Medigap Insurance
crossover claim
40. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
phantom billing
(OOPs) Out of Pocket Costs/Expenses
subscriber
self-referral
41. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
privacy
consent
(TPA) Third Party Administrator
Individually identifiable health information
42. 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
(COBRA)
Maximum Out Of Pocket
Supplementary Medical Insurance
(PAC) Pre- Admission Certification
43. 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
prepaid plan
clearinghouse
Assignment & Authorization
(PCN) Primary Care Network
44. American Medical Association
covered entity
state preemption
Protected health information
AMA
45. Is a provider who sends the patients for testing or treatment
referring physician
confidentiality
authorization form
covered entity
46. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(PPS) Hospital Impatient Prospective Payment System
Privileged information
security officer
47. 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
pos
(ERISA) Employee Retirement Income Security Act of 1974
open panel HMO
48. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
electronic media
claim
prepaid plan
49. 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
Privacy officer
Referral
(PAC) Pre- Admission Certification
50. A willful act by an employee of taking possession of an employer's money
(PAC) Pre- Admission Certification
Embezzlement
Confidential communication
(Non-par) Non-Participating Provider
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