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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. A nonprofit integrated delivery system
ids
medical foundation
electronic media
(UR) Utilization review
2. 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.
Privileged information
Treating or performing physician
Beneficiary
claim
3. 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
(AOB) Assignment of Benefits
nonprivileged information
breach of confidential communication
epo
4. 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
premium
AMA
(DME) Durable Medical Equipment
covered entity
5. 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
Pre-existing Condition Exclusion
(PCN) Primary Care Network
abuse
(POS) Point-of Service Plan
6. 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.
Specialist
(PCN) Primary Care Network
Privileged information
(DRG's)
7. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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8. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(PCP) Primary Care Physician
pcp
(EPO) Exclusive Provider Organization
(COBRA)
9. An organization of provider sites with a contracted relationship that offer services
electronic media
Pre-certification
ids
epo
10. 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
(DME) Durable Medical Equipment
Individually identifiable health information
Experimental Procedures
authorization form
11. The condition of being secluded from the presence or view of others.
(PCN) Primary Care Network
Treating or performing physician
(DME) Durable Medical Equipment
privacy
12. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
phantom billing
epo
Treating or performing physician
13. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
ordering physician
pos
health care provider
disclosure
14. 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
Covered Expenses
Confidential communication
Open Enrollment
15. Is a provider who sends the patients for testing or treatment
electronic media
Preauthorization
Assignment & Authorization
referring physician
16. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(DME) Durable Medical Equipment
(POS) Point-of Service Plan
Covered Expenses
17. Standards of conduct generally accepted as a moral guide for behavior.
Covered Expenses
ethics
ids
attending physician
18. 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
(ABN) Advance Beneficiary Notice
Pre-certification
(DRG's)
abuse
19. 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
Amblatory Care
Treating or performing physician
complience plan
(PCN) Primary Care Network
20. 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
phantom billing
nonprivileged information
(PCN) Primary Care Network
Maximum Out Of Pocket
21. A patient claim is eligible for medicare and medicaid
(PCP) Primary Care Physician
etiquette
(PEC) Pre-existing condition
crossover claim
22. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
(Non-par) Non-Participating Provider
Medigap Insurance
Beneficiary
23. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(AOB) Assignment of Benefits
(TPA) Third Party Administrator
Privileged information
claim
24. A review of the need for inpatient hospital care - completed before the actual admission
electronic media
Open Enrollment
(AOB) Assignment of Benefits
(PAC) Pre- Admission Certification
25. 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
(TPA) Third Party Administrator
authorization form
preauthorization
econdary Payer
26. 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
referring physician
(POS) Point-of Service Plan
deductible
(PCP) Primary Care Physician
27. 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
Out of Network (OON)
Consent form
(UR) Utilization review
Supplementary Medical Insurance
28. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
ee schedule
Amblatory Care
electronic media
29. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
complience
(COB) Coordination of Benefits
authorization form
Subscriber
30. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
Resonable Charge
preauthorization
Claim
31. American Medical Association
Consent form
premium
Open Enrollment
AMA
32. A clinic that is owned by the HMO and the physicians are employees of the HMO
attending physician
(OOPs) Out of Pocket Costs/Expenses
closed panel HMO
complience
33. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
business associate
Consent form
(UCR) Usual - Customary and Reasonable
pos
34. 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
ee schedule
(EPO) Exclusive Provider Organization
referring physician
Participating Provider
35. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(ABN) Advance Beneficiary Notice
Referral
(UR) Utilization review
Specialist
36. 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
Network
self-referral
Medigap Insurance
37. 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
fraud
(DRG's)
etiquette
Sub-acute Care
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
(COBRA)
Security Rule
Resonable Charge
state preemption
39. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(POS) Point-of Service Plan
Pre-certification
AMA
ordering physician
40. 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
Treating or performing physician
Confidential communication
(POS) Point-of Service Plan
clearinghouse
41. A rule - condition - or requirement
complience plan
Amblatory Care
Standard
ethics
42. Billing for services not performed
closed panel HMO
pos
phantom billing
Treating or performing physician
43. 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)
transaction
Consent form
subscriber
Coordinated Coverage
44. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(TPA) Third Party Administrator
ppo
fraud
45. An intentional misrepresentation of the facts to deceive or mislead another.
prepaid plan
fraud
Protected health information
Pre-certification
46. 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
(DME) Durable Medical Equipment
(EPO) Exclusive Provider Organization
covered entity
prepaid plan
47. The maximum amount a plan pays for a covered service
transaction
Consent form
abuse
Allowed Expenses
48. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Pre-certification
(DCI) Duplicate Coverage Inquiry
Claim
IIHI
49. 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
IIHI
Supplementary Medical Insurance
crossover claim
50. 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.
referral
(PCP) Primary Care Physician
security officer
business associate