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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.
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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. 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
ethics
Participating Provider
complience
(ERISA) Employee Retirement Income Security Act of 1974
2. Is the provider who renders a service to a patient
phantom billing
crossover claim
Out of Network (OON)
Treating or performing physician
3. 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
Subscriber
authorization form
phantom billing
hmo
4. Customs - rules of conduct - courtesy - and manners of the medical profession
Individually identifiable health information
etiquette
attending physician
fraud
5. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
covered entity
Security Rule
(UR) Utilization review
Notice of Privacy Practices
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
pcp
Privacy officer
Preauthorization
Network
7. A provision that apples when a person is covered under more than one group medical program
Referral
(COBRA)
(COB) Coordination of Benefits
benefit period
8. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
benefit period
Medigap Insurance
preauthorization
(DME) Durable Medical Equipment
9. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
ppo
self-referral
premium
(OOPs) Out of Pocket Costs/Expenses
10. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
disclosure
ee schedule
business associate
electronic media
11. A physician - the majority of whose practice is devoted to internal medicine - family/general practice and pediatrics. An ob/gyn sometimes is considerd a primary care physician depending on coverage
breach of confidential communication
(PCP) Primary Care Physician
econdary Payer
security officer
12. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
Notice of Privacy Practices
medical foundation
preauthorization
13. A monthly fee paid by the insured for specific medical insurance coverage
Consent form
Supplementary Medical Insurance
Privacy officer
premium
14. 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
(Non-par) Non-Participating Provider
Treating or performing physician
Assignment & Authorization
etiquette
15. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
(PCP) Primary Care Physician
Specialist
ids
16. An organization of provider sites with a contracted relationship that offer services
ids
Beneficiary
business associate
(DME) Durable Medical Equipment
17. A review of the need for inpatient hospital care - completed before the actual admission
covered entity
Standard
(PPS) Hospital Impatient Prospective Payment System
(PAC) Pre- Admission Certification
18. A review of the need for inpatient hospital care - completed before the actual admission
Privacy officer
Embezzlement
authorization form
(PAC) Pre- Admission Certification
19. 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
Covered Expenses
(UCR) Usual - Customary and Reasonable
Notice of Privacy Practices
20. 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.
benefit period
Security Rule
state preemption
Notice of Privacy Practices
21. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(TPA) Third Party Administrator
complience plan
Referral
Subscriber
22. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
Network
Consent form
ee schedule
23. 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
Standard
business associate
open panel HMO
(Non-par) Non-Participating Provider
24. 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
(ABN) Advance Beneficiary Notice
self-referral
epo
nonprivileged information
25. A health insurance enrollee chooses to see an out of network provider without authorization
(PCN) Primary Care Network
self-referral
preauthorization
HIPAA
26. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
(PPS) Hospital Impatient Prospective Payment System
(ABN) Advance Beneficiary Notice
Claim
27. Health Information Portability and Accountability Act
Medigap Insurance
clearinghouse
HIPAA
Security Rule
28. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
abuse
open panel HMO
referral
attending physician
29. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
benefit period
(ABN) Advance Beneficiary Notice
Standard
Specialist
30. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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31. 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
prepaid plan
covered entity
open panel HMO
(UR) Utilization review
32. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(PPS) Hospital Impatient Prospective Payment System
Referral
ids
(POS) Point-of Service Plan
33. 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.
Privileged information
Protected health information
(PCN) Primary Care Network
Coordinated Coverage
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
ids
(Non-par) Non-Participating Provider
closed panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
35. 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
(PCN) Primary Care Network
(ABN) Advance Beneficiary Notice
security officer
benefit period
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.
Claim
ordering physician
Privileged information
Notice of Privacy Practices
37. A list of the amount to be paid by an insurance company for each procedure service
(Non-par) Non-Participating Provider
electronic media
Open Enrollment
ee schedule
38. Medicare's method of paying acute care hospitals for inpatient care
medical foundation
(PPS) Hospital Impatient Prospective Payment System
Security Rule
closed panel HMO
39. 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
Pre-existing Condition Exclusion
Network
clearinghouse
Standard
40. A privileged communication that may be disclosed only with the patient's permission.
Treating or performing physician
referring physician
ppo
Confidential communication
41. A patient claim is eligible for medicare and medicaid
state preemption
crossover claim
hmo
(PCN) Primary Care Network
42. A rule - condition - or requirement
ppo
state preemption
Standard
Network
43. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
claim
(ABN) Advance Beneficiary Notice
Medigap Insurance
consulting physician
44. 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
ids
epo
(ERISA) Employee Retirement Income Security Act of 1974
open panel HMO
45. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
clearinghouse
Security Rule
Treating or performing physician
46. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
Referral
benefit period
subscriber
47. 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
Treating or performing physician
Confidential communication
epo
48. A privileged communication that may be disclosed only with the patient's permission.
authorization form
(COB) Coordination of Benefits
Confidential communication
(COBRA)
49. American Medical Association
premium
(UR) Utilization review
AMA
claim
50. 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
(POS) Point-of Service Plan
Pre-existing Condition Exclusion
epo
Specialist