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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 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
medical foundation
(PAC) Pre- Admission Certification
Supplementary Medical Insurance
ee schedule
2. 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
(TPA) Third Party Administrator
Protected health information
subscriber
3. Medicare's method of paying acute care hospitals for inpatient care
electronic media
(PPS) Hospital Impatient Prospective Payment System
electronic media
(UCR) Usual - Customary and Reasonable
4. 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)
premium
fraud
Consent form
(PPS) Hospital Impatient Prospective Payment System
5. 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)
Security Rule
authorization form
Pre-certification
6. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
(DOS) Date of Service
health care provider
(PCP) Primary Care Physician
7. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
complience
transaction
hmo
fraud
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
Supplementary Medical Insurance
disclosure
fraud
Amblatory Care
9. 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
privacy
confidentiality
transaction
(ABN) Advance Beneficiary Notice
10. A clinic that is owned by the HMO and the physicians are employees of the HMO
self-referral
premium
(ABN) Advance Beneficiary Notice
closed panel HMO
11. An organization of provider sites with a contracted relationship that offer services
Privileged information
ids
covered entity
(PPS) Hospital Impatient Prospective Payment System
12. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(PPS) Hospital Impatient Prospective Payment System
Resonable Charge
phantom billing
complience
13. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Deductible
state preemption
electronic media
security officer
14. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(APC) Ambulatory Patient Classifications
disclosure
Participating Provider
Privileged information
15. 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
fraud
authorization form
AMA
(DME) Durable Medical Equipment
16. Integrating benefits payable under more than one health insurance.
preauthorization
Security Rule
Coordinated Coverage
Pre-certification
17. A list of the amount to be paid by an insurance company for each procedure service
Treating or performing physician
ee schedule
health care provider
phantom billing
18. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Supplementary Medical Insurance
Notice of Privacy Practices
clearinghouse
(POS) Point-of Service Plan
19. American Medical Association
HIPAA
AMA
(PPS) Hospital Impatient Prospective Payment System
Open Enrollment
20. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
state preemption
(UCR) Usual - Customary and Reasonable
Security Rule
prepaid plan
21. 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
disclosure
(POS) Point-of Service Plan
medical foundation
(COBRA)
22. 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
(COBRA)
Sub-acute Care
ordering physician
closed panel HMO
23. 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
ordering physician
referring physician
(AOB) Assignment of Benefits
(ABN) Advance Beneficiary Notice
24. 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
Pre-existing Condition Exclusion
confidentiality
consulting physician
25. Health Information Portability and Accountability Act
ordering physician
attending physician
transaction
HIPAA
26. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
ordering physician
Assignment & Authorization
Privacy officer
complience
27. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Specialist
clearinghouse
complience
Open Enrollment
28. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Deductible
abuse
Claim
Embezzlement
29. A provision that apples when a person is covered under more than one group medical program
authorization form
(COB) Coordination of Benefits
(COBRA)
complience
30. 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
Security Rule
Amblatory Care
Open Enrollment
open panel HMO
31. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Sub-acute Care
disclosure
Referral
Participating Provider
32. Someone who is eligible for or receiving benefits under an insurance policy or plan
clearinghouse
referring physician
Consent form
Beneficiary
33. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Pre-existing Condition Exclusion
Individually identifiable health information
Assignment & Authorization
(PCP) Primary Care Physician
34. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Network
complience plan
(PCN) Primary Care Network
etiquette
35. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(DCI) Duplicate Coverage Inquiry
Individually identifiable health information
Medigap Insurance
self-referral
36. 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
econdary Payer
etiquette
security officer
crossover claim
37. A nonprofit integrated delivery system
(PEC) Pre-existing condition
Allowed Expenses
medical foundation
(DOS) Date of Service
38. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
privacy
(APC) Ambulatory Patient Classifications
(POS) Point-of Service Plan
39. 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
health care provider
Deductible
(PCP) Primary Care Physician
claim
40. A monthly fee paid by the insured for specific medical insurance coverage
premium
Notice of Privacy Practices
Beneficiary
AMA
41. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Experimental Procedures
(DCI) Duplicate Coverage Inquiry
(ERISA) Employee Retirement Income Security Act of 1974
42. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Embezzlement
Participating Provider
confidentiality
43. Is the provider who renders a service to a patient
Treating or performing physician
(POS) Point-of Service Plan
(DME) Durable Medical Equipment
consulting physician
44. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Out of Network (OON)
Notice of Privacy Practices
(PCP) Primary Care Physician
45. 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
Privacy officer
(PCN) Primary Care Network
(DME) Durable Medical Equipment
nonprivileged information
46. A health insurance enrollee chooses to see an out of network provider without authorization
(PCP) Primary Care Physician
ethics
Standard
self-referral
47. Billing for services not performed
AMA
Individually identifiable health information
Medigap Insurance
phantom billing
48. The period of time that payment for Medicare inpatient hospital benefits are available
(AOB) Assignment of Benefits
disclosure
benefit period
ethics
49. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
referral
(UR) Utilization review
(DME) Durable Medical Equipment
disclosure
50. 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.
premium
econdary Payer
ethics
state preemption
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