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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Privacy officer
Referral
premium
privacy
2. 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
(EPO) Exclusive Provider Organization
e-health information management
Notice of Privacy Practices
3. Integrating benefits payable under more than one health insurance.
Beneficiary
Treating or performing physician
Coordinated Coverage
epo
4. 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
benefit period
pos
fraud
open panel HMO
5. A willful act by an employee of taking possession of an employer's money
Out of Network (OON)
Security Rule
Notice of Privacy Practices
Embezzlement
6. 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
Preauthorization
ethics
self-referral
IIHI
7. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(OOPs) Out of Pocket Costs/Expenses
(PEC) Pre-existing condition
benefit period
(UCR) Usual - Customary and Reasonable
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
(POS) Point-of Service Plan
Participating Provider
ids
Privacy officer
9. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Consent form
econdary Payer
(POS) Point-of Service Plan
electronic media
10. 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.
(UR) Utilization review
Privileged information
Subscriber
health care provider
11. 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
state preemption
disclosure
(EPO) Exclusive Provider Organization
Pre-existing Condition Exclusion
12. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
consent
e-health information management
(AOB) Assignment of Benefits
13. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
nonprivileged information
privacy
(DCI) Duplicate Coverage Inquiry
Individually identifiable health information
14. Individually identifiable health information
(UR) Utilization review
(PCP) Primary Care Physician
Embezzlement
IIHI
15. A clinic that is owned by the HMO and the physicians are employees of the HMO
ppo
closed panel HMO
crossover claim
attending physician
16. An organization of provider sites with a contracted relationship that offer services
premium
Beneficiary
ids
pos
17. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
disclosure
(DRG's)
Medigap Insurance
pcp
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.
subscriber
Treating or performing physician
Individually identifiable health information
confidentiality
19. 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
(PPS) Hospital Impatient Prospective Payment System
pcp
authorization form
(OOPs) Out of Pocket Costs/Expenses
20. 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
(OOPs) Out of Pocket Costs/Expenses
Experimental Procedures
state preemption
closed panel HMO
21. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(UCR) Usual - Customary and Reasonable
Embezzlement
clearinghouse
Supplementary Medical Insurance
22. 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
referring physician
ordering physician
Coordinated Coverage
23. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Notice of Privacy Practices
AMA
econdary Payer
24. 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
Confidential communication
(AOB) Assignment of Benefits
open panel HMO
premium
25. Health Information Portability and Accountability Act
HIPAA
Covered Expenses
(TPA) Third Party Administrator
state preemption
26. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
open panel HMO
medical foundation
consulting physician
27. 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
referral
nonprivileged information
authorization form
(UCR) Usual - Customary and Reasonable
28. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Protected health information
(EPO) Exclusive Provider Organization
ppo
Claim
29. Is the provider who renders a service to a patient
Privileged information
deductible
etiquette
Treating or performing physician
30. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Notice of Privacy Practices
complience plan
Security Rule
31. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
ethics
clearinghouse
subscriber
electronic media
32. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Security Rule
(PPS) Hospital Impatient Prospective Payment System
Claim
33. 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
business associate
pos
security officer
Open Enrollment
34. 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
Preauthorization
Covered Expenses
(Non-par) Non-Participating Provider
(TPA) Third Party Administrator
35. 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
abuse
(COB) Coordination of Benefits
(DOS) Date of Service
(PCN) Primary Care Network
36. 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
closed panel HMO
(Non-par) Non-Participating Provider
Out of Network (OON)
Privacy officer
37. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(DOS) Date of Service
(PEC) Pre-existing condition
covered entity
disclosure
38. 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.
(DME) Durable Medical Equipment
Pre-existing Condition Exclusion
crossover claim
Notice of Privacy Practices
39. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
Protected health information
(UR) Utilization review
(DRG's)
40. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Resonable Charge
subscriber
self-referral
econdary Payer
41. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(TPA) Third Party Administrator
(Non-par) Non-Participating Provider
IIHI
42. 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
closed panel HMO
(APC) Ambulatory Patient Classifications
nonprivileged information
Assignment & Authorization
43. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method
Pre-existing Condition Exclusion
transaction
Confidential communication
epo
44. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
ordering physician
prepaid plan
referral
Pre-certification
45. 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
subscriber
health care provider
ids
Pre-existing Condition Exclusion
46. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
self-referral
Medigap Insurance
ordering physician
Specialist
47. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Sub-acute Care
claim
disclosure
Treating or performing physician
48. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
pcp
ee schedule
disclosure
ppo
49. Billing for services not performed
(OOPs) Out of Pocket Costs/Expenses
business associate
phantom billing
Specialist
50. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
business associate
Privileged information
clearinghouse
(Non-par) Non-Participating Provider