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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. A health insurance enrollee chooses to see an out of network provider without authorization
ordering physician
Confidential communication
consent
self-referral
2. Is a provider who sends the patients for testing or treatment
referring physician
benefit period
Network
ordering physician
3. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
econdary Payer
ee schedule
Pre-existing Condition Exclusion
4. 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
pos
(ERISA) Employee Retirement Income Security Act of 1974
(DRG's)
Participating Provider
5. The amount of actual money available to the medical practice
Claim
Assignment & Authorization
cash flow
benefit period
6. 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
epo
(DCI) Duplicate Coverage Inquiry
complience
7. 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
Subscriber
(EPO) Exclusive Provider Organization
Participating Provider
8. 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
(DME) Durable Medical Equipment
Subscriber
Supplementary Medical Insurance
complience plan
9. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
pos
(DME) Durable Medical Equipment
subscriber
pos
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)
(PCP) Primary Care Physician
(PCN) Primary Care Network
Consent form
econdary Payer
11. A nonprofit integrated delivery system
Deductible
medical foundation
(Non-par) Non-Participating Provider
e-health information management
12. A clinic that is owned by the HMO and the physicians are employees of the HMO
Privacy officer
Sub-acute Care
epo
closed panel HMO
13. 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
pos
Out of Network (OON)
Amblatory Care
econdary Payer
14. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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15. 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
Sub-acute Care
complience
abuse
Deductible
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.
Network
Notice of Privacy Practices
(COBRA)
(DRG's)
17. 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
Subscriber
cash flow
authorization form
transaction
18. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
(UCR) Usual - Customary and Reasonable
premium
Specialist
19. 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
ppo
transaction
Experimental Procedures
Individually identifiable health information
20. 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
Open Enrollment
ppo
benefit period
(DOS) Date of Service
21. 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
Resonable Charge
Protected health information
(ABN) Advance Beneficiary Notice
22. American Medical Association
AMA
prepaid plan
(APC) Ambulatory Patient Classifications
consent
23. 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
cash flow
ppo
(COB) Coordination of Benefits
24. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Amblatory Care
Beneficiary
(EPO) Exclusive Provider Organization
Resonable Charge
25. 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.
Specialist
HIPAA
e-health information management
Privacy officer
26. An organization of provider sites with a contracted relationship that offer services
ids
(PCP) Primary Care Physician
Protected health information
claim
27. A monthly fee paid by the insured for specific medical insurance coverage
premium
(DCI) Duplicate Coverage Inquiry
(DOS) Date of Service
e-health information management
28. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
clearinghouse
(Non-par) Non-Participating Provider
(POS) Point-of Service Plan
29. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
nonprivileged information
Preauthorization
(COBRA)
Claim
30. A provision that apples when a person is covered under more than one group medical program
pos
cash flow
(COB) Coordination of Benefits
(APC) Ambulatory Patient Classifications
31. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Consent form
pcp
Referral
Network
32. The maximum amount a plan pays for a covered service
(UCR) Usual - Customary and Reasonable
Allowed Expenses
Resonable Charge
ppo
33. 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.
(PCP) Primary Care Physician
security officer
(POS) Point-of Service Plan
benefit period
34. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
ethics
nonprivileged information
subscriber
35. The maximum amount a plan pays for a covered service
subscriber
Allowed Expenses
transaction
hmo
36. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(PCP) Primary Care Physician
Pre-certification
pcp
Specialist
37. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
clearinghouse
Embezzlement
open panel HMO
Subscriber
38. 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.
IIHI
Protected health information
phantom billing
(COBRA)
39. 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
ee schedule
referring physician
prepaid plan
40. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Deductible
(ABN) Advance Beneficiary Notice
security officer
(DCI) Duplicate Coverage Inquiry
41. 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)
(PCN) Primary Care Network
deductible
Consent form
Allowed Expenses
42. The dates of healthcare services were provided to the beneficiary
(AOB) Assignment of Benefits
fraud
Notice of Privacy Practices
(DOS) Date of Service
43. 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
disclosure
ordering physician
(DOS) Date of Service
econdary Payer
44. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
complience
ppo
business associate
claim
45. A patient claim is eligible for medicare and medicaid
Open Enrollment
crossover claim
AMA
state preemption
46. Medical staff member who is legally responsible for the care and treatment given to a patient.
(ABN) Advance Beneficiary Notice
authorization form
attending physician
AMA
47. Verbal or written agreement that gives approval to some action - situation - or statement.
Protected health information
consent
prepaid plan
business associate
48. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Privacy officer
electronic media
(ABN) Advance Beneficiary Notice
Standard
49. An intentional misrepresentation of the facts to deceive or mislead another.
benefit period
(UR) Utilization review
fraud
(Non-par) Non-Participating Provider
50. 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
ee schedule
Sub-acute Care
complience plan
Embezzlement