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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
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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. 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.
(PPS) Hospital Impatient Prospective Payment System
(COB) Coordination of Benefits
Privileged information
Amblatory Care
2. The maximum amount a plan pays for a covered service
Allowed Expenses
subscriber
disclosure
business associate
3. Individually identifiable health information
(UCR) Usual - Customary and Reasonable
nonprivileged information
(ABN) Advance Beneficiary Notice
IIHI
4. 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
preauthorization
covered entity
ee schedule
Assignment & Authorization
5. Billing for services not performed
Embezzlement
electronic media
Participating Provider
phantom billing
6. A nonprofit integrated delivery system
medical foundation
(EPO) Exclusive Provider Organization
preauthorization
(UR) Utilization review
7. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
Medigap Insurance
security officer
pcp
8. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
consulting physician
Preauthorization
Amblatory Care
9. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
business associate
(AOB) Assignment of Benefits
complience plan
(PCP) Primary Care Physician
10. 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
Preauthorization
covered entity
(PCN) Primary Care Network
Participating Provider
11. Medical services provided on an outpatient basis
ethics
Amblatory Care
Deductible
Protected health information
12. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Resonable Charge
breach of confidential communication
consulting physician
Amblatory Care
13. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Pre-existing Condition Exclusion
abuse
closed panel HMO
(UR) Utilization review
14. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
HIPAA
pcp
Specialist
(ERISA) Employee Retirement Income Security Act of 1974
15. 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
Supplementary Medical Insurance
e-health information management
disclosure
16. The dates of healthcare services were provided to the beneficiary
Amblatory Care
(DOS) Date of Service
transaction
phantom billing
17. 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
breach of confidential communication
Deductible
18. A list of the amount to be paid by an insurance company for each procedure service
(AOB) Assignment of Benefits
claim
Experimental Procedures
ee schedule
19. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
closed panel HMO
Experimental Procedures
Specialist
20. Medicare's method of paying acute care hospitals for inpatient care
clearinghouse
claim
(PPS) Hospital Impatient Prospective Payment System
abuse
21. 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
Security Rule
complience plan
Security Rule
Preauthorization
22. Medical services provided on an outpatient basis
electronic media
Amblatory Care
covered entity
disclosure
23. A provision that apples when a person is covered under more than one group medical program
Beneficiary
Privacy officer
Covered Expenses
(COB) Coordination of Benefits
24. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Resonable Charge
(PEC) Pre-existing condition
Individually identifiable health information
hmo
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.
benefit period
consent
state preemption
health care provider
26. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(DRG's)
Individually identifiable health information
Medigap Insurance
27. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Protected health information
fraud
open panel HMO
28. 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
Embezzlement
health care provider
epo
Covered Expenses
29. 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
(DCI) Duplicate Coverage Inquiry
covered entity
Beneficiary
premium
30. A willful act by an employee of taking possession of an employer's money
(DOS) Date of Service
Notice of Privacy Practices
state preemption
Embezzlement
31. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
electronic media
benefit period
(OOPs) Out of Pocket Costs/Expenses
Network
32. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DCI) Duplicate Coverage Inquiry
Medigap Insurance
referral
Assignment & Authorization
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.
Open Enrollment
pcp
Resonable Charge
Protected health information
34. 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.
(AOB) Assignment of Benefits
Sub-acute Care
Notice of Privacy Practices
nonprivileged information
35. 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
claim
econdary Payer
(UR) Utilization review
pcp
36. 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
Deductible
premium
consulting physician
37. A willful act by an employee of taking possession of an employer's money
subscriber
referring physician
Embezzlement
deductible
38. 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
(COBRA)
Maximum Out Of Pocket
(DME) Durable Medical Equipment
Referral
39. 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
Resonable Charge
Covered Expenses
premium
40. 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
Consent form
Consent form
41. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
medical foundation
(TPA) Third Party Administrator
Claim
Consent form
42. Health Information Portability and Accountability Act
privacy
business associate
HIPAA
(PPS) Hospital Impatient Prospective Payment System
43. 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
(DCI) Duplicate Coverage Inquiry
disclosure
business associate
Out of Network (OON)
44. Is a provider who sends the patients for testing or treatment
benefit period
referring physician
Preauthorization
pos
45. An organization of provider sites with a contracted relationship that offer services
Open Enrollment
fraud
ids
Embezzlement
46. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Privileged information
Allowed Expenses
(UCR) Usual - Customary and Reasonable
ee schedule
47. 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
covered entity
e-health information management
(APC) Ambulatory Patient Classifications
48. American Medical Association
consent
Standard
(Non-par) Non-Participating Provider
AMA
49. 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
complience
closed panel HMO
ordering physician
50. 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
Standard
covered entity
attending physician
(COBRA)