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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. 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
Maximum Out Of Pocket
etiquette
fraud
Pre-existing Condition Exclusion
2. Health Information Portability and Accountability Act
Pre-certification
HIPAA
AMA
Subscriber
3. 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.
attending physician
Notice of Privacy Practices
confidentiality
Referral
4. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
referral
(POS) Point-of Service Plan
complience
5. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(APC) Ambulatory Patient Classifications
Pre-existing Condition Exclusion
(UCR) Usual - Customary and Reasonable
Referral
6. Approval or consent by a primary physician for patient referral to ancillary services and specialists
complience
Confidential communication
hmo
Referral
7. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Maximum Out Of Pocket
security officer
(DCI) Duplicate Coverage Inquiry
privacy
8. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
clearinghouse
subscriber
Deductible
9. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
IIHI
crossover claim
electronic media
10. 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
Participating Provider
Preauthorization
Privacy officer
transaction
11. A review of the need for inpatient hospital care - completed before the actual admission
transaction
security officer
Amblatory Care
(PAC) Pre- Admission Certification
12. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
deductible
AMA
phantom billing
13. 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
ethics
IIHI
(ERISA) Employee Retirement Income Security Act of 1974
prepaid plan
14. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
epo
open panel HMO
ordering physician
complience
15. Billing for services not performed
phantom billing
(DOS) Date of Service
covered entity
Coordinated Coverage
16. 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.
ethics
referring physician
Notice of Privacy Practices
crossover claim
17. 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
referring physician
Sub-acute Care
open panel HMO
Preauthorization
18. The amount of actual money available to the medical practice
cash flow
Participating Provider
state preemption
open panel HMO
19. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
pcp
Assignment & Authorization
consulting physician
econdary Payer
20. An organization of provider sites with a contracted relationship that offer services
open panel HMO
state preemption
ids
Security Rule
21. 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
subscriber
ppo
Privacy officer
22. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Protected health information
(APC) Ambulatory Patient Classifications
attending physician
transaction
23. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
complience plan
clearinghouse
Experimental Procedures
Security Rule
24. A privileged communication that may be disclosed only with the patient's permission.
(COBRA)
covered entity
hmo
Confidential communication
25. Is the provider who renders a service to a patient
Confidential communication
Treating or performing physician
ethics
transaction
26. 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
disclosure
(DOS) Date of Service
nonprivileged information
(Non-par) Non-Participating Provider
27. 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
subscriber
Sub-acute Care
Open Enrollment
(DRG's)
28. 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
econdary Payer
ppo
ee schedule
Experimental Procedures
29. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
covered entity
pos
benefit period
30. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Amblatory Care
AMA
clearinghouse
31. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
consulting physician
Sub-acute Care
Treating or performing physician
32. 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
Assignment & Authorization
ee schedule
premium
33. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
crossover claim
Coordinated Coverage
Sub-acute Care
34. 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
closed panel HMO
prepaid plan
Supplementary Medical Insurance
35. 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
benefit period
Assignment & Authorization
ethics
(PCP) Primary Care Physician
36. A list of the amount to be paid by an insurance company for each procedure service
(OOPs) Out of Pocket Costs/Expenses
Subscriber
ee schedule
complience plan
37. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
referring physician
Medigap Insurance
e-health information management
38. A health insurance enrollee chooses to see an out of network provider without authorization
(POS) Point-of Service Plan
self-referral
AMA
Standard
39. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Preauthorization
preauthorization
Medigap Insurance
(ABN) Advance Beneficiary Notice
40. 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.
Amblatory Care
security officer
nonprivileged information
(COB) Coordination of Benefits
41. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
authorization form
Medigap Insurance
complience
(DOS) Date of Service
42. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
Claim
(PCP) Primary Care Physician
Pre-certification
43. The dates of healthcare services were provided to the beneficiary
(POS) Point-of Service Plan
ee schedule
(DOS) Date of Service
fraud
44. Customs - rules of conduct - courtesy - and manners of the medical profession
ordering physician
Notice of Privacy Practices
covered entity
etiquette
45. An intentional misrepresentation of the facts to deceive or mislead another.
consulting physician
premium
fraud
Notice of Privacy Practices
46. 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
Participating Provider
Treating or performing physician
Network
47. A nonprofit integrated delivery system
complience plan
medical foundation
Standard
disclosure
48. Individually identifiable health information
Participating Provider
Referral
IIHI
(TPA) Third Party Administrator
49. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
transaction
Network
benefit period
50. 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
Participating Provider
complience
pos
Deductible