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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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.
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. 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
Assignment & Authorization
(Non-par) Non-Participating Provider
e-health information management
epo
2. Customs - rules of conduct - courtesy - and manners of the medical profession
phantom billing
cash flow
etiquette
Sub-acute Care
3. Billing for services not performed
phantom billing
(TPA) Third Party Administrator
Deductible
(PCP) Primary Care Physician
4. The maximum amount a plan pays for a covered service
AMA
pcp
HIPAA
Allowed Expenses
5. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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6. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
health care provider
authorization form
ordering physician
(UCR) Usual - Customary and Reasonable
7. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
cash flow
Coordinated Coverage
premium
8. 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
(UR) Utilization review
complience
epo
premium
9. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(PEC) Pre-existing condition
Embezzlement
Subscriber
Pre-certification
10. Health Information Portability and Accountability Act
HIPAA
(DOS) Date of Service
Embezzlement
e-health information management
11. 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
premium
Covered Expenses
confidentiality
(PCN) Primary Care Network
12. A willful act by an employee of taking possession of an employer's money
(PAC) Pre- Admission Certification
covered entity
(PPS) Hospital Impatient Prospective Payment System
Embezzlement
13. Billing for services not performed
phantom billing
cash flow
crossover claim
Open Enrollment
14. A health insurance enrollee chooses to see an out of network provider without authorization
Sub-acute Care
preauthorization
e-health information management
self-referral
15. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
(PPS) Hospital Impatient Prospective Payment System
(PAC) Pre- Admission Certification
Preauthorization
16. 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
premium
Sub-acute Care
(AOB) Assignment of Benefits
claim
17. Standards of conduct generally accepted as a moral guide for behavior.
closed panel HMO
Security Rule
medical foundation
ethics
18. Approval or consent by a primary physician for patient referral to ancillary services and specialists
e-health information management
epo
Referral
(DRG's)
19. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Beneficiary
subscriber
(PAC) Pre- Admission Certification
preauthorization
20. 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
Protected health information
Assignment & Authorization
(UR) Utilization review
health care provider
21. 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
econdary Payer
Preauthorization
pcp
22. A monthly fee paid by the insured for specific medical insurance coverage
premium
ids
abuse
Referral
23. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Covered Expenses
clearinghouse
hmo
(ABN) Advance Beneficiary Notice
24. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(EPO) Exclusive Provider Organization
econdary Payer
deductible
business associate
25. The amount of actual money available to the medical practice
cash flow
Privileged information
(AOB) Assignment of Benefits
closed panel HMO
26. 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
preauthorization
(ABN) Advance Beneficiary Notice
(DRG's)
(DOS) Date of Service
27. 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
consulting physician
ethics
(TPA) Third Party Administrator
(PCP) Primary Care Physician
28. 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
covered entity
ppo
open panel HMO
Open Enrollment
29. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pos
pcp
complience plan
(TPA) Third Party Administrator
30. 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
privacy
ethics
Privileged information
31. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Privacy officer
self-referral
Pre-certification
(EPO) Exclusive Provider Organization
32. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Referral
abuse
crossover claim
(PEC) Pre-existing condition
33. 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.
epo
(PEC) Pre-existing condition
business associate
(Non-par) Non-Participating Provider
34. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
pos
ordering physician
(POS) Point-of Service Plan
35. 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
pcp
Sub-acute Care
Medigap Insurance
ids
36. A privileged communication that may be disclosed only with the patient's permission.
complience
Confidential communication
disclosure
subscriber
37. 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
Participating Provider
Preauthorization
Standard
ordering physician
38. American Medical Association
deductible
AMA
(COBRA)
electronic media
39. 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.
IIHI
Privileged information
transaction
Participating Provider
40. 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
closed panel HMO
(DME) Durable Medical Equipment
Treating or performing physician
Embezzlement
41. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
nonprivileged information
Medigap Insurance
Privileged information
(DCI) Duplicate Coverage Inquiry
42. 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
clearinghouse
(COBRA)
(DOS) Date of Service
referring physician
43. Someone who is eligible for or receiving benefits under an insurance policy or plan
hmo
Beneficiary
Medigap Insurance
(DRG's)
44. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
consulting physician
Confidential communication
e-health information management
Maximum Out Of Pocket
45. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Claim
open panel HMO
crossover claim
electronic media
46. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
complience
(ABN) Advance Beneficiary Notice
open panel HMO
47. 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.
confidentiality
Confidential communication
Notice of Privacy Practices
security officer
48. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
crossover claim
(PAC) Pre- Admission Certification
(PAC) Pre- Admission Certification
49. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
benefit period
claim
(OOPs) Out of Pocket Costs/Expenses
business associate
50. 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
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
(EPO) Exclusive Provider Organization
Claim