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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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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. 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
deductible
(AOB) Assignment of Benefits
(EPO) Exclusive Provider Organization
(ABN) Advance Beneficiary Notice
2. 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
Pre-certification
Sub-acute Care
(EPO) Exclusive Provider Organization
cash flow
3. A patient claim is eligible for medicare and medicaid
ethics
nonprivileged information
crossover claim
state preemption
4. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
hmo
Notice of Privacy Practices
subscriber
(COB) Coordination of Benefits
5. A health insurance enrollee chooses to see an out of network provider without authorization
crossover claim
Open Enrollment
self-referral
open panel HMO
6. Unauthorized release of information
(PEC) Pre-existing condition
referring physician
breach of confidential communication
epo
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
epo
referral
crossover claim
Experimental Procedures
8. Medical staff member who is legally responsible for the care and treatment given to a patient.
IIHI
premium
Open Enrollment
attending physician
9. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
hmo
(TPA) Third Party Administrator
(APC) Ambulatory Patient Classifications
(EPO) Exclusive Provider Organization
10. 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
breach of confidential communication
Sub-acute Care
(COBRA)
(AOB) Assignment of Benefits
11. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Allowed Expenses
closed panel HMO
Participating Provider
12. 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
(COBRA)
econdary Payer
(PCP) Primary Care Physician
electronic media
13. Integrating benefits payable under more than one health insurance.
Covered Expenses
complience
Individually identifiable health information
Coordinated Coverage
14. 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
(PCN) Primary Care Network
Out of Network (OON)
subscriber
AMA
15. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
cash flow
complience plan
pcp
Network
16. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Security Rule
ids
referral
(PCP) Primary Care Physician
17. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Claim
(EPO) Exclusive Provider Organization
consulting physician
Consent form
18. 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
complience
Supplementary Medical Insurance
etiquette
crossover claim
19. Medical staff member who is legally responsible for the care and treatment given to a patient.
(ERISA) Employee Retirement Income Security Act of 1974
preauthorization
attending physician
Treating or performing physician
20. 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
claim
Allowed Expenses
covered entity
ppo
21. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
prepaid plan
Standard
Medigap Insurance
Resonable Charge
22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
cash flow
econdary Payer
(COBRA)
abuse
23. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(TPA) Third Party Administrator
claim
(DCI) Duplicate Coverage Inquiry
transaction
24. Individually identifiable health information
Network
Treating or performing physician
econdary Payer
IIHI
25. 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
subscriber
benefit period
Coordinated Coverage
26. 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.
pos
Privacy officer
Sub-acute Care
security officer
27. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Network
Deductible
benefit period
hmo
28. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
open panel HMO
consent
pos
clearinghouse
29. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(PCN) Primary Care Network
business associate
Embezzlement
30. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
pos
abuse
(TPA) Third Party Administrator
Network
31. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
subscriber
etiquette
(PAC) Pre- Admission Certification
confidentiality
32. Someone who is eligible for or receiving benefits under an insurance policy or plan
(PEC) Pre-existing condition
(UCR) Usual - Customary and Reasonable
complience plan
Beneficiary
33. 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
HIPAA
econdary Payer
(POS) Point-of Service Plan
(Non-par) Non-Participating Provider
34. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
covered entity
Network
(UR) Utilization review
preauthorization
35. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
privacy
Open Enrollment
Resonable Charge
ids
36. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(APC) Ambulatory Patient Classifications
cash flow
Claim
confidentiality
37. 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.
(PAC) Pre- Admission Certification
security officer
prepaid plan
Sub-acute Care
38. 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
(AOB) Assignment of Benefits
(OOPs) Out of Pocket Costs/Expenses
Beneficiary
39. 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
Individually identifiable health information
preauthorization
Security Rule
(UCR) Usual - Customary and Reasonable
40. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
breach of confidential communication
Experimental Procedures
covered entity
41. An organization of provider sites with a contracted relationship that offer services
ids
Open Enrollment
Coordinated Coverage
Security Rule
42. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Pre-existing Condition Exclusion
Out of Network (OON)
(EPO) Exclusive Provider Organization
complience
43. A clinic that is owned by the HMO and the physicians are employees of the HMO
security officer
Security Rule
hmo
closed panel HMO
44. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
claim
AMA
(COBRA)
45. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
confidentiality
Maximum Out Of Pocket
claim
Pre-certification
46. 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
(DRG's)
Embezzlement
(PCN) Primary Care Network
(PCP) Primary Care Physician
47. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
48. 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
Protected health information
Medigap Insurance
disclosure
49. 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.
(DCI) Duplicate Coverage Inquiry
Privacy officer
Pre-existing Condition Exclusion
Treating or performing physician
50. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
disclosure
Open Enrollment
self-referral
Individually identifiable health information