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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. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
confidentiality
HIPAA
complience plan
referral
2. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Notice of Privacy Practices
Medigap Insurance
disclosure
(DCI) Duplicate Coverage Inquiry
3. Unauthorized release of information
breach of confidential communication
ppo
IIHI
deductible
4. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Protected health information
ee schedule
cash flow
5. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
phantom billing
Coordinated Coverage
electronic media
Resonable Charge
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.
privacy
confidentiality
(PCP) Primary Care Physician
Specialist
7. 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
claim
(DCI) Duplicate Coverage Inquiry
epo
Participating Provider
8. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Individually identifiable health information
ids
Pre-certification
complience
9. 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.
Security Rule
business associate
state preemption
Preauthorization
10. Standards of conduct generally accepted as a moral guide for behavior.
(EPO) Exclusive Provider Organization
ordering physician
cash flow
ethics
11. The maximum amount a plan pays for a covered service
(PCN) Primary Care Network
claim
Allowed Expenses
Pre-existing Condition Exclusion
12. 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
ppo
Allowed Expenses
Preauthorization
privacy
13. 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
Supplementary Medical Insurance
(UCR) Usual - Customary and Reasonable
Open Enrollment
Embezzlement
14. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(TPA) Third Party Administrator
Network
AMA
referring physician
15. 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
Embezzlement
preauthorization
pos
(AOB) Assignment of Benefits
16. Medical services provided on an outpatient basis
etiquette
ethics
Amblatory Care
ee schedule
17. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
AMA
medical foundation
phantom billing
(OOPs) Out of Pocket Costs/Expenses
18. 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
referring physician
open panel HMO
disclosure
cash flow
19. 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
AMA
cash flow
Consent form
Experimental Procedures
20. 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.
AMA
Privacy officer
ids
(POS) Point-of Service Plan
21. 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
Supplementary Medical Insurance
econdary Payer
Deductible
Subscriber
22. A privileged communication that may be disclosed only with the patient's permission.
(EPO) Exclusive Provider Organization
Confidential communication
e-health information management
Protected health information
23. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Protected health information
Referral
covered entity
24. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Experimental Procedures
Protected health information
Allowed Expenses
complience plan
25. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Supplementary Medical Insurance
transaction
Sub-acute Care
26. Integrating benefits payable under more than one health insurance.
referral
consulting physician
Coordinated Coverage
(Non-par) Non-Participating Provider
27. The transmission of information between two parties to carry out financial or administrative activities related to health care.
consent
deductible
IIHI
transaction
28. 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
(ERISA) Employee Retirement Income Security Act of 1974
Security Rule
cash flow
consulting physician
29. 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
(COB) Coordination of Benefits
Sub-acute Care
referral
(DME) Durable Medical Equipment
30. The period of time that payment for Medicare inpatient hospital benefits are available
(DCI) Duplicate Coverage Inquiry
Network
complience
benefit period
31. 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
Medigap Insurance
claim
Out of Network (OON)
Assignment & Authorization
32. 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
Pre-existing Condition Exclusion
Medigap Insurance
(AOB) Assignment of Benefits
econdary Payer
33. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
epo
breach of confidential communication
Pre-existing Condition Exclusion
34. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
transaction
self-referral
Amblatory Care
preauthorization
35. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
nonprivileged information
Preauthorization
(UCR) Usual - Customary and Reasonable
self-referral
36. Unauthorized release of information
breach of confidential communication
(DOS) Date of Service
(COBRA)
self-referral
37. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
econdary Payer
Allowed Expenses
prepaid plan
(AOB) Assignment of Benefits
38. 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
Amblatory Care
Sub-acute Care
Amblatory Care
Security Rule
39. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
attending physician
Participating Provider
(OOPs) Out of Pocket Costs/Expenses
(PAC) Pre- Admission Certification
40. 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.
Out of Network (OON)
IIHI
business associate
(DME) Durable Medical Equipment
41. A nonprofit integrated delivery system
abuse
Individually identifiable health information
complience plan
medical foundation
42. A monthly fee paid by the insured for specific medical insurance coverage
(ERISA) Employee Retirement Income Security Act of 1974
medical foundation
(PCN) Primary Care Network
premium
43. Medical staff member who is legally responsible for the care and treatment given to a patient.
Pre-certification
attending physician
Confidential communication
(DME) Durable Medical Equipment
44. 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
medical foundation
Preauthorization
IIHI
(PCP) Primary Care Physician
45. A structure for classifying outpatient services and procedures for purpose of payment
pos
Beneficiary
ee schedule
(APC) Ambulatory Patient Classifications
46. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Beneficiary
state preemption
cash flow
47. Verbal or written agreement that gives approval to some action - situation - or statement.
AMA
Preauthorization
(ERISA) Employee Retirement Income Security Act of 1974
consent
48. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
self-referral
referring physician
prepaid plan
Pre-certification
49. 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)
Confidential communication
(Non-par) Non-Participating Provider
transaction
Consent form
50. 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.
premium
Open Enrollment
Privileged information
(ABN) Advance Beneficiary Notice