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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. 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.
prepaid plan
Notice of Privacy Practices
epo
cash flow
2. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(DOS) Date of Service
ordering physician
Privacy officer
prepaid plan
3. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Privacy officer
Pre-certification
(COBRA)
confidentiality
4. 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
(DRG's)
Coordinated Coverage
state preemption
Security Rule
5. What the insurance company will consider paying for as defined in the contract.
Maximum Out Of Pocket
electronic media
Covered Expenses
(DME) Durable Medical Equipment
6. 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.
breach of confidential communication
privacy
(APC) Ambulatory Patient Classifications
health care provider
7. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
consulting physician
Covered Expenses
(DME) Durable Medical Equipment
8. An intentional misrepresentation of the facts to deceive or mislead another.
Network
benefit period
Sub-acute Care
fraud
9. The condition of being secluded from the presence or view of others.
consent
privacy
benefit period
benefit period
10. 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
attending physician
consent
ppo
open panel HMO
11. 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.
Consent form
Protected health information
Deductible
deductible
12. 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
(AOB) Assignment of Benefits
Deductible
(TPA) Third Party Administrator
nonprivileged information
13. 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
Preauthorization
(APC) Ambulatory Patient Classifications
referring physician
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Supplementary Medical Insurance
Protected health information
consulting physician
Preauthorization
15. Customs - rules of conduct - courtesy - and manners of the medical profession
(EPO) Exclusive Provider Organization
Specialist
HIPAA
etiquette
16. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
disclosure
cash flow
prepaid plan
17. 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
Preauthorization
open panel HMO
Subscriber
Deductible
18. 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
(PCP) Primary Care Physician
Security Rule
(PCN) Primary Care Network
Medigap Insurance
19. Integrating benefits payable under more than one health insurance.
Specialist
(APC) Ambulatory Patient Classifications
Coordinated Coverage
Participating Provider
20. 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
(PAC) Pre- Admission Certification
(Non-par) Non-Participating Provider
(PAC) Pre- Admission Certification
21. 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
(COBRA)
abuse
Maximum Out Of Pocket
Pre-existing Condition Exclusion
22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
disclosure
Beneficiary
abuse
clearinghouse
23. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Pre-existing Condition Exclusion
subscriber
Embezzlement
ordering physician
24. 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
electronic media
(DCI) Duplicate Coverage Inquiry
(PEC) Pre-existing condition
(PCP) Primary Care Physician
25. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
complience plan
referral
(PCP) Primary Care Physician
(POS) Point-of Service Plan
26. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
cash flow
Pre-certification
authorization form
ids
27. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
abuse
(DME) Durable Medical Equipment
(DRG's)
(POS) Point-of Service Plan
28. 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
(AOB) Assignment of Benefits
(PAC) Pre- Admission Certification
phantom billing
Covered Expenses
29. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Participating Provider
disclosure
Protected health information
30. Verbal or written agreement that gives approval to some action - situation - or statement.
Experimental Procedures
subscriber
pcp
consent
31. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
hmo
e-health information management
(UCR) Usual - Customary and Reasonable
(Non-par) Non-Participating Provider
32. A nonprofit integrated delivery system
medical foundation
covered entity
Pre-certification
Resonable Charge
33. An organization of provider sites with a contracted relationship that offer services
(ABN) Advance Beneficiary Notice
ppo
ids
crossover claim
34. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
econdary Payer
(UCR) Usual - Customary and Reasonable
Allowed Expenses
pcp
35. The period of time that payment for Medicare inpatient hospital benefits are available
(DCI) Duplicate Coverage Inquiry
benefit period
privacy
(PAC) Pre- Admission Certification
36. Individually identifiable health information
(DRG's)
(AOB) Assignment of Benefits
(TPA) Third Party Administrator
IIHI
37. 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.
Protected health information
Amblatory Care
self-referral
Notice of Privacy Practices
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
Security Rule
premium
referring physician
transaction
39. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
(PCN) Primary Care Network
crossover claim
Allowed Expenses
40. Is the provider who renders a service to a patient
Resonable Charge
clearinghouse
Treating or performing physician
ethics
41. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
clearinghouse
Resonable Charge
hmo
Sub-acute Care
42. A monthly fee paid by the insured for specific medical insurance coverage
Confidential communication
premium
prepaid plan
pcp
43. 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
consulting physician
(EPO) Exclusive Provider Organization
Open Enrollment
transaction
44. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Open Enrollment
Referral
hmo
Embezzlement
45. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
premium
hmo
ethics
Consent form
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
premium
Referral
(AOB) Assignment of Benefits
Specialist
47. 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
Confidential communication
authorization form
medical foundation
Claim
48. 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
Privacy officer
(EPO) Exclusive Provider Organization
breach of confidential communication
Pre-existing Condition Exclusion
49. A nonprofit integrated delivery system
hmo
medical foundation
(DRG's)
Individually identifiable health information
50. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Individually identifiable health information
open panel HMO
abuse