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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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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. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Consent form
Coordinated Coverage
Pre-certification
Preauthorization
2. Verbal or written agreement that gives approval to some action - situation - or statement.
state preemption
consent
prepaid plan
(ABN) Advance Beneficiary Notice
3. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
medical foundation
electronic media
Network
4. 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
prepaid plan
complience plan
Protected health information
(COBRA)
5. Medical services provided on an outpatient basis
attending physician
Amblatory Care
(DME) Durable Medical Equipment
disclosure
6. 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
consulting physician
(APC) Ambulatory Patient Classifications
open panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
7. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
referring physician
Experimental Procedures
e-health information management
(PCN) Primary Care Network
8. 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
open panel HMO
Network
phantom billing
Out of Network (OON)
9. A provision that apples when a person is covered under more than one group medical program
Confidential communication
authorization form
(COB) Coordination of Benefits
ordering physician
10. 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)
Resonable Charge
Consent form
pcp
privacy
11. Is the provider who renders a service to a patient
Treating or performing physician
transaction
Security Rule
Pre-existing Condition Exclusion
12. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
self-referral
medical foundation
Preauthorization
13. A rule - condition - or requirement
(PCN) Primary Care Network
Standard
Supplementary Medical Insurance
Beneficiary
14. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(DCI) Duplicate Coverage Inquiry
(OOPs) Out of Pocket Costs/Expenses
ee schedule
closed panel HMO
15. 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
cash flow
disclosure
econdary Payer
abuse
16. 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
cash flow
(ERISA) Employee Retirement Income Security Act of 1974
benefit period
Sub-acute Care
17. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(UR) Utilization review
Coordinated Coverage
crossover claim
18. The condition of being secluded from the presence or view of others.
privacy
breach of confidential communication
IIHI
confidentiality
19. 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
Deductible
(DOS) Date of Service
Medigap Insurance
Out of Network (OON)
20. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
breach of confidential communication
(DME) Durable Medical Equipment
Sub-acute Care
Claim
21. 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.
Privacy officer
privacy
benefit period
ordering physician
22. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
abuse
Standard
Amblatory Care
disclosure
23. 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
Assignment & Authorization
Supplementary Medical Insurance
self-referral
ethics
24. 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
self-referral
deductible
Privacy officer
Assignment & Authorization
25. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Maximum Out Of Pocket
(UR) Utilization review
crossover claim
26. 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
clearinghouse
Privacy officer
(ERISA) Employee Retirement Income Security Act of 1974
Embezzlement
27. Individually identifiable health information
IIHI
disclosure
Out of Network (OON)
(PCP) Primary Care Physician
28. 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
(PEC) Pre-existing condition
(COBRA)
(APC) Ambulatory Patient Classifications
ppo
29. 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
Allowed Expenses
(DME) Durable Medical Equipment
authorization form
Pre-existing Condition Exclusion
30. A monthly fee paid by the insured for specific medical insurance coverage
referring physician
pos
abuse
premium
31. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
ppo
(AOB) Assignment of Benefits
Supplementary Medical Insurance
32. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
breach of confidential communication
cash flow
abuse
33. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
epo
(TPA) Third Party Administrator
Assignment & Authorization
attending physician
34. Is the provider who renders a service to a patient
Treating or performing physician
Pre-existing Condition Exclusion
Deductible
Experimental Procedures
35. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Treating or performing physician
deductible
(DME) Durable Medical Equipment
Individually identifiable health information
36. 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
e-health information management
subscriber
(Non-par) Non-Participating Provider
(PPS) Hospital Impatient Prospective Payment System
37. An organization of provider sites with a contracted relationship that offer services
ids
self-referral
electronic media
(AOB) Assignment of Benefits
38. 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
(ABN) Advance Beneficiary Notice
ids
authorization form
Claim
39. 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
cash flow
ppo
preauthorization
(COB) Coordination of Benefits
40. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
premium
Consent form
Network
Covered Expenses
41. American Medical Association
transaction
AMA
Beneficiary
referring physician
42. 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 officer
AMA
(DRG's)
Security Rule
43. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Beneficiary
cash flow
Allowed Expenses
clearinghouse
44. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Privileged information
consent
deductible
45. 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.
(ABN) Advance Beneficiary Notice
Privacy officer
Privileged information
crossover claim
46. 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.
Protected health information
(ERISA) Employee Retirement Income Security Act of 1974
Privacy officer
Deductible
47. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Sub-acute Care
confidentiality
econdary Payer
ethics
48. 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
(DRG's)
security officer
consent
Out of Network (OON)
49. 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
(COB) Coordination of Benefits
(PPS) Hospital Impatient Prospective Payment System
abuse
pos
50. 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
phantom billing
AMA
(TPA) Third Party Administrator