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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 managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
closed panel HMO
Treating or performing physician
transaction
2. 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
Experimental Procedures
(AOB) Assignment of Benefits
(UR) Utilization review
(COB) Coordination of Benefits
3. 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
(APC) Ambulatory Patient Classifications
consent
electronic media
4. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(COB) Coordination of Benefits
complience
Assignment & Authorization
5. 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
Security Rule
(DME) Durable Medical Equipment
privacy
Security Rule
6. Someone who is eligible for or receiving benefits under an insurance policy or plan
Security Rule
Beneficiary
Deductible
state preemption
7. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
phantom billing
(UR) Utilization review
Allowed Expenses
covered entity
8. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
econdary Payer
(EPO) Exclusive Provider Organization
consulting physician
9. 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
Treating or performing physician
(PCP) Primary Care Physician
abuse
(UR) Utilization review
10. Customs - rules of conduct - courtesy - and manners of the medical profession
Referral
etiquette
abuse
(EPO) Exclusive Provider Organization
11. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
referral
e-health information management
hmo
disclosure
12. 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
Deductible
(UCR) Usual - Customary and Reasonable
Security Rule
pos
13. A review of the need for inpatient hospital care - completed before the actual admission
(APC) Ambulatory Patient Classifications
(PAC) Pre- Admission Certification
epo
Specialist
14. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(DCI) Duplicate Coverage Inquiry
Protected health information
covered entity
claim
15. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
econdary Payer
(OOPs) Out of Pocket Costs/Expenses
crossover claim
consent
16. 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
Specialist
subscriber
(Non-par) Non-Participating Provider
(DME) Durable Medical Equipment
17. 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.
pcp
Privileged information
Deductible
referral
18. 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.
Supplementary Medical Insurance
health care provider
Protected health information
Privacy officer
19. 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
Coordinated Coverage
closed panel HMO
benefit period
Open Enrollment
20. A monthly fee paid by the insured for specific medical insurance coverage
Participating Provider
premium
Claim
referring physician
21. 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)
Consent form
(COB) Coordination of Benefits
confidentiality
Embezzlement
22. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
ethics
Claim
security officer
(DRG's)
23. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
consent
ordering physician
Referral
Claim
24. 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
attending physician
fraud
etiquette
25. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
prepaid plan
Claim
authorization form
Pre-certification
26. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
(PPS) Hospital Impatient Prospective Payment System
Preauthorization
Out of Network (OON)
27. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
state preemption
Allowed Expenses
Notice of Privacy Practices
covered entity
28. 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
Pre-certification
attending physician
Embezzlement
29. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Referral
(UCR) Usual - Customary and Reasonable
Embezzlement
ordering physician
30. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
prepaid plan
closed panel HMO
preauthorization
31. The period of time that payment for Medicare inpatient hospital benefits are available
Referral
benefit period
ids
medical foundation
32. 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
Notice of Privacy Practices
pos
ordering physician
(ABN) Advance Beneficiary Notice
33. A nonprofit integrated delivery system
medical foundation
claim
ee schedule
Preauthorization
34. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(PCP) Primary Care Physician
(Non-par) Non-Participating Provider
(APC) Ambulatory Patient Classifications
claim
35. 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
Assignment & Authorization
referring physician
open panel HMO
(PCP) Primary Care Physician
36. What the insurance company will consider paying for as defined in the contract.
Embezzlement
(DOS) Date of Service
Resonable Charge
Covered Expenses
37. Medicare's method of paying acute care hospitals for inpatient care
transaction
(PPS) Hospital Impatient Prospective Payment System
(EPO) Exclusive Provider Organization
medical foundation
38. A willful act by an employee of taking possession of an employer's money
epo
pcp
referral
Embezzlement
39. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
pcp
AMA
econdary Payer
40. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Amblatory Care
(UR) Utilization review
(DCI) Duplicate Coverage Inquiry
complience
41. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Assignment & Authorization
(AOB) Assignment of Benefits
Medigap Insurance
Network
42. 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
Sub-acute Care
ee schedule
(AOB) Assignment of Benefits
ppo
43. 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
(EPO) Exclusive Provider Organization
Consent form
Security Rule
44. 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
(ERISA) Employee Retirement Income Security Act of 1974
preauthorization
Standard
Amblatory Care
45. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
deductible
Network
Consent form
econdary Payer
46. 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
deductible
ethics
(PCN) Primary Care Network
(PAC) Pre- Admission Certification
47. The amount of actual money available to the medical practice
(ERISA) Employee Retirement Income Security Act of 1974
(ABN) Advance Beneficiary Notice
privacy
cash flow
48. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(PCP) Primary Care Physician
(TPA) Third Party Administrator
(APC) Ambulatory Patient Classifications
Individually identifiable health information
49. The maximum amount a plan pays for a covered service
(TPA) Third Party Administrator
abuse
Allowed Expenses
self-referral
50. Is a provider who sends the patients for testing or treatment
deductible
referring physician
fraud
Participating Provider