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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. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
etiquette
(Non-par) Non-Participating Provider
(DRG's)
clearinghouse
2. Verbal or written agreement that gives approval to some action - situation - or statement.
(PAC) Pre- Admission Certification
e-health information management
(PCP) Primary Care Physician
consent
3. 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
referring physician
consulting physician
premium
(DME) Durable Medical Equipment
4. 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.
(COBRA)
health care provider
Treating or performing physician
Protected health information
5. Is a provider who sends the patients for testing or treatment
subscriber
referring physician
attending physician
e-health information management
6. The dates of healthcare services were provided to the beneficiary
Assignment & Authorization
(DOS) Date of Service
state preemption
Resonable Charge
7. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(Non-par) Non-Participating Provider
subscriber
Network
Referral
8. Medicare's method of paying acute care hospitals for inpatient care
Individually identifiable health information
(PPS) Hospital Impatient Prospective Payment System
(ERISA) Employee Retirement Income Security Act of 1974
security officer
9. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Claim
ee schedule
Experimental Procedures
10. Integrating benefits payable under more than one health insurance.
Network
clearinghouse
(PCN) Primary Care Network
Coordinated Coverage
11. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(PCP) Primary Care Physician
Out of Network (OON)
Allowed Expenses
Specialist
12. Individually identifiable health information
IIHI
hmo
(DCI) Duplicate Coverage Inquiry
ids
13. 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
(ERISA) Employee Retirement Income Security Act of 1974
preauthorization
(Non-par) Non-Participating Provider
14. The maximum amount a plan pays for a covered service
Resonable Charge
Treating or performing physician
Allowed Expenses
consulting physician
15. The condition of being secluded from the presence or view of others.
privacy
(ERISA) Employee Retirement Income Security Act of 1974
consent
Individually identifiable health information
16. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
Pre-certification
Participating Provider
(COBRA)
(ERISA) Employee Retirement Income Security Act of 1974
17. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(TPA) Third Party Administrator
prepaid plan
Individually identifiable health information
self-referral
18. Integrating benefits payable under more than one health insurance.
(PAC) Pre- Admission Certification
Coordinated Coverage
Specialist
(DOS) Date of Service
19. Medical staff member who is legally responsible for the care and treatment given to a patient.
subscriber
attending physician
(COBRA)
Network
20. 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
econdary Payer
Subscriber
ids
(PCN) Primary Care Network
21. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
AMA
clearinghouse
e-health information management
22. The transmission of information between two parties to carry out financial or administrative activities related to health care.
benefit period
transaction
(DOS) Date of Service
Network
23. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Treating or performing physician
(TPA) Third Party Administrator
HIPAA
business associate
24. A clinic that is owned by the HMO and the physicians are employees of the HMO
Network
crossover claim
(UR) Utilization review
closed panel HMO
25. Medicare's method of paying acute care hospitals for inpatient care
HIPAA
Notice of Privacy Practices
authorization form
(PPS) Hospital Impatient Prospective Payment System
26. 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
nonprivileged information
(PCP) Primary Care Physician
Assignment & Authorization
(DME) Durable Medical Equipment
27. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
cash flow
(UCR) Usual - Customary and Reasonable
(COBRA)
medical foundation
28. 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
authorization form
confidentiality
Confidential communication
Specialist
29. 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
Subscriber
nonprivileged information
(UCR) Usual - Customary and Reasonable
30. Is a provider who sends the patients for testing or treatment
etiquette
(OOPs) Out of Pocket Costs/Expenses
Assignment & Authorization
referring physician
31. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
etiquette
phantom billing
privacy
Pre-certification
32. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(TPA) Third Party Administrator
(DCI) Duplicate Coverage Inquiry
(PAC) Pre- Admission Certification
preauthorization
33. 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
Pre-existing Condition Exclusion
Pre-existing Condition Exclusion
(ERISA) Employee Retirement Income Security Act of 1974
Notice of Privacy Practices
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
(Non-par) Non-Participating Provider
Covered Expenses
Confidential communication
35. Medical services provided on an outpatient basis
ee schedule
complience
privacy
Amblatory Care
36. Billing for services not performed
(PPS) Hospital Impatient Prospective Payment System
prepaid plan
phantom billing
premium
37. 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
(Non-par) Non-Participating Provider
disclosure
privacy
(ABN) Advance Beneficiary Notice
38. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
consulting physician
Maximum Out Of Pocket
Protected health information
prepaid plan
39. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Amblatory Care
Security Rule
subscriber
self-referral
40. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Open Enrollment
Sub-acute Care
security officer
41. American Medical Association
Allowed Expenses
AMA
medical foundation
Maximum Out Of Pocket
42. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
medical foundation
deductible
preauthorization
43. 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.
(AOB) Assignment of Benefits
security officer
Out of Network (OON)
consent
44. A patient claim is eligible for medicare and medicaid
ids
crossover claim
(EPO) Exclusive Provider Organization
(ABN) Advance Beneficiary Notice
45. A nonprofit integrated delivery system
security officer
medical foundation
Medigap Insurance
Pre-existing Condition Exclusion
46. 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
referring physician
(AOB) Assignment of Benefits
prepaid plan
phantom billing
47. 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
abuse
epo
e-health information management
Consent form
48. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(COBRA)
closed panel HMO
referring physician
Pre-certification
49. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ee schedule
ordering physician
claim
(PCP) Primary Care Physician
50. Billing for services not performed
Deductible
security officer
phantom billing
Claim