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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. The maximum amount a plan pays for a covered service
pos
claim
Covered Expenses
Allowed Expenses
2. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
phantom billing
Pre-existing Condition Exclusion
(DOS) Date of Service
3. 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
claim
authorization form
Experimental Procedures
4. 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
Assignment & Authorization
(AOB) Assignment of Benefits
(UR) Utilization review
Maximum Out Of Pocket
5. 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
security officer
(PCN) Primary Care Network
Maximum Out Of Pocket
Deductible
6. Individually identifiable health information
IIHI
(Non-par) Non-Participating Provider
subscriber
epo
7. 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
hmo
medical foundation
Security Rule
(COB) Coordination of Benefits
8. Billing for services not performed
preauthorization
phantom billing
(OOPs) Out of Pocket Costs/Expenses
breach of confidential communication
9. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Notice of Privacy Practices
cash flow
Individually identifiable health information
Network
10. 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
(PAC) Pre- Admission Certification
Security Rule
Participating Provider
(POS) Point-of Service Plan
11. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
pos
covered entity
breach of confidential communication
hmo
12. 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
Coordinated Coverage
Covered Expenses
authorization form
Protected health information
13. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
complience plan
Deductible
Treating or performing physician
14. 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
Confidential communication
e-health information management
Coordinated Coverage
(ABN) Advance Beneficiary Notice
15. 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
(PCP) Primary Care Physician
Specialist
referring physician
Pre-existing Condition Exclusion
16. The amount of actual money available to the medical practice
Assignment & Authorization
cash flow
crossover claim
Specialist
17. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
Pre-existing Condition Exclusion
(DCI) Duplicate Coverage Inquiry
epo
18. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
state preemption
claim
electronic media
Specialist
19. 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
prepaid plan
Allowed Expenses
(PPS) Hospital Impatient Prospective Payment System
20. 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)
Confidential communication
Consent form
referring physician
ordering physician
21. A willful act by an employee of taking possession of an employer's money
state preemption
health care provider
authorization form
Embezzlement
22. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
referring physician
Consent form
(PEC) Pre-existing condition
HIPAA
23. 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.
(PEC) Pre-existing condition
self-referral
Privileged information
(POS) Point-of Service Plan
24. 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
Coordinated Coverage
state preemption
Network
25. 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
complience plan
(DME) Durable Medical Equipment
attending physician
26. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(POS) Point-of Service Plan
Medigap Insurance
self-referral
abuse
27. Medical staff member who is legally responsible for the care and treatment given to a patient.
(DOS) Date of Service
covered entity
Medigap Insurance
attending physician
28. 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
phantom billing
Consent form
pos
29. 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
IIHI
Individually identifiable health information
abuse
Deductible
30. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Claim
(COB) Coordination of Benefits
e-health information management
(POS) Point-of Service Plan
31. Customs - rules of conduct - courtesy - and manners of the medical profession
cash flow
etiquette
hmo
referral
32. 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
Confidential communication
(DME) Durable Medical Equipment
(COBRA)
medical foundation
33. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(ERISA) Employee Retirement Income Security Act of 1974
disclosure
business associate
covered entity
34. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Confidential communication
disclosure
security officer
Out of Network (OON)
35. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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36. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
nonprivileged information
Pre-existing Condition Exclusion
Privileged information
referral
37. Is the provider who renders a service to a patient
confidentiality
abuse
Treating or performing physician
referral
38. 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.
AMA
Subscriber
business associate
(PCP) Primary Care Physician
39. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Allowed Expenses
Out of Network (OON)
ids
40. 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
ee schedule
ppo
(COBRA)
covered entity
41. Integrating benefits payable under more than one health insurance.
Supplementary Medical Insurance
Coordinated Coverage
health care provider
hmo
42. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
abuse
(TPA) Third Party Administrator
electronic media
benefit period
43. Customs - rules of conduct - courtesy - and manners of the medical profession
IIHI
etiquette
(POS) Point-of Service Plan
attending physician
44. A patient claim is eligible for medicare and medicaid
self-referral
(POS) Point-of Service Plan
crossover claim
Pre-certification
45. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
epo
hmo
abuse
consulting physician
46. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
ids
crossover claim
Deductible
47. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
(ABN) Advance Beneficiary Notice
hmo
premium
(POS) Point-of Service Plan
48. 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.
Protected health information
state preemption
(OOPs) Out of Pocket Costs/Expenses
consent
49. 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
Pre-existing Condition Exclusion
security officer
subscriber
Out of Network (OON)
50. A health insurance enrollee chooses to see an out of network provider without authorization
phantom billing
self-referral
Specialist
Covered Expenses