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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. Standards of conduct generally accepted as a moral guide for behavior.
Maximum Out Of Pocket
ethics
Standard
pos
2. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(OOPs) Out of Pocket Costs/Expenses
disclosure
Referral
privacy
3. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
electronic media
preauthorization
clearinghouse
Beneficiary
4. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(DRG's)
subscriber
attending physician
health care provider
5. 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)
Consent form
cash flow
clearinghouse
Covered Expenses
6. 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
Deductible
confidentiality
(COB) Coordination of Benefits
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.
(UR) Utilization review
Maximum Out Of Pocket
Notice of Privacy Practices
Privacy officer
8. Standards of conduct generally accepted as a moral guide for behavior.
IIHI
Pre-existing Condition Exclusion
ethics
consulting physician
9. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
transaction
(AOB) Assignment of Benefits
Allowed Expenses
(TPA) Third Party Administrator
10. 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
Consent form
ppo
(APC) Ambulatory Patient Classifications
Covered Expenses
11. Health Information Portability and Accountability Act
closed panel HMO
ordering physician
HIPAA
Network
12. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(OOPs) Out of Pocket Costs/Expenses
referring physician
ordering physician
electronic media
13. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
HIPAA
phantom billing
fraud
e-health information management
14. A review of the need for inpatient hospital care - completed before the actual admission
Allowed Expenses
Protected health information
(PAC) Pre- Admission Certification
confidentiality
15. 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
(PCN) Primary Care Network
(COBRA)
pos
econdary Payer
16. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(EPO) Exclusive Provider Organization
pcp
consent
prepaid plan
17. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(COBRA)
(APC) Ambulatory Patient Classifications
(UR) Utilization review
crossover claim
18. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
health care provider
(PCP) Primary Care Physician
Pre-existing Condition Exclusion
19. 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
Out of Network (OON)
Claim
(PCP) Primary Care Physician
(PPS) Hospital Impatient Prospective Payment System
20. Medicare's method of paying acute care hospitals for inpatient care
referral
(PPS) Hospital Impatient Prospective Payment System
Security Rule
ee schedule
21. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(OOPs) Out of Pocket Costs/Expenses
econdary Payer
pcp
22. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
security officer
Subscriber
nonprivileged information
23. 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
Specialist
health care provider
confidentiality
(DME) Durable Medical Equipment
24. A rule - condition - or requirement
(EPO) Exclusive Provider Organization
Standard
covered entity
(UR) Utilization review
25. 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
nonprivileged information
disclosure
consent
Assignment & Authorization
26. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(PCN) Primary Care Network
claim
benefit period
epo
27. 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
referral
Deductible
disclosure
covered entity
28. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Open Enrollment
complience
Privileged information
Deductible
29. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
confidentiality
(PAC) Pre- Admission Certification
breach of confidential communication
30. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
benefit period
referring physician
subscriber
31. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
econdary Payer
self-referral
Amblatory Care
32. 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
ethics
Participating Provider
breach of confidential communication
(OOPs) Out of Pocket Costs/Expenses
33. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(ABN) Advance Beneficiary Notice
e-health information management
cash flow
(UCR) Usual - Customary and Reasonable
34. 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
Experimental Procedures
closed panel HMO
ethics
(COBRA)
35. 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
Treating or performing physician
Sub-acute Care
claim
Security Rule
36. 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
state preemption
Beneficiary
Notice of Privacy Practices
Out of Network (OON)
37. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
state preemption
(DRG's)
deductible
Privacy officer
38. A willful act by an employee of taking possession of an employer's money
Embezzlement
transaction
Treating or performing physician
prepaid plan
39. 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.
(PEC) Pre-existing condition
business associate
privacy
(DRG's)
40. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
confidentiality
(AOB) Assignment of Benefits
Participating Provider
preauthorization
41. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.
self-referral
health care provider
Preauthorization
Participating Provider
42. Integrating benefits payable under more than one health insurance.
(COB) Coordination of Benefits
Coordinated Coverage
Consent form
(DME) Durable Medical Equipment
43. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
e-health information management
Participating Provider
(DRG's)
Claim
44. 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
(TPA) Third Party Administrator
Sub-acute Care
e-health information management
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.
Privileged information
Notice of Privacy Practices
security officer
e-health information management
46. 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
health care provider
AMA
self-referral
(PCN) Primary Care Network
47. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
confidentiality
(PEC) Pre-existing condition
hmo
(DCI) Duplicate Coverage Inquiry
48. Is the provider who renders a service to a patient
premium
subscriber
Maximum Out Of Pocket
Treating or performing physician
49. 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)
(COBRA)
Consent form
Participating Provider
Treating or performing physician
50. An organization of provider sites with a contracted relationship that offer services
(DCI) Duplicate Coverage Inquiry
complience
fraud
ids