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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 written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
privacy
claim
abuse
(APC) Ambulatory Patient Classifications
2. 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
Beneficiary
Experimental Procedures
Deductible
Resonable Charge
3. 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
(Non-par) Non-Participating Provider
(DME) Durable Medical Equipment
(PPS) Hospital Impatient Prospective Payment System
IIHI
4. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
(UR) Utilization review
(PEC) Pre-existing condition
(EPO) Exclusive Provider Organization
5. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(POS) Point-of Service Plan
clearinghouse
Specialist
Network
6. 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
(DCI) Duplicate Coverage Inquiry
(ABN) Advance Beneficiary Notice
epo
pos
7. A health insurance enrollee chooses to see an out of network provider without authorization
epo
Confidential communication
Experimental Procedures
self-referral
8. The period of time that payment for Medicare inpatient hospital benefits are available
Maximum Out Of Pocket
cash flow
benefit period
Deductible
9. 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.
IIHI
Claim
Notice of Privacy Practices
Claim
10. 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
clearinghouse
(AOB) Assignment of Benefits
claim
AMA
11. 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
authorization form
(UCR) Usual - Customary and Reasonable
(PCP) Primary Care Physician
Pre-certification
12. 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.
(COBRA)
security officer
Treating or performing physician
health care provider
13. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
referral
hmo
subscriber
breach of confidential communication
14. A privileged communication that may be disclosed only with the patient's permission.
business associate
disclosure
Standard
Confidential communication
15. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
nonprivileged information
Coordinated Coverage
(UCR) Usual - Customary and Reasonable
AMA
16. American Medical Association
nonprivileged information
health care provider
AMA
IIHI
17. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
Supplementary Medical Insurance
Beneficiary
Out of Network (OON)
18. 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
subscriber
claim
Participating Provider
19. Is a provider who sends the patients for testing or treatment
referring physician
closed panel HMO
privacy
attending physician
20. 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.
(OOPs) Out of Pocket Costs/Expenses
Preauthorization
self-referral
state preemption
21. Approval or consent by a primary physician for patient referral to ancillary services and specialists
prepaid plan
state preemption
Consent form
Referral
22. Verbal or written agreement that gives approval to some action - situation - or statement.
Specialist
HIPAA
consent
transaction
23. 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
Open Enrollment
health care provider
premium
medical foundation
24. The amount of actual money available to the medical practice
(DCI) Duplicate Coverage Inquiry
cash flow
Assignment & Authorization
Network
25. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
ppo
Experimental Procedures
privacy
Preauthorization
26. 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
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
Confidential communication
referral
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.
clearinghouse
attending physician
closed panel HMO
(EPO) Exclusive Provider Organization
28. A nonprofit integrated delivery system
(COBRA)
Embezzlement
Allowed Expenses
medical foundation
29. 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
authorization form
Medigap Insurance
Maximum Out Of Pocket
HIPAA
30. An organization of provider sites with a contracted relationship that offer services
medical foundation
ids
complience plan
Treating or performing physician
31. 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
(Non-par) Non-Participating Provider
consent
referring physician
Pre-existing Condition Exclusion
32. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
security officer
nonprivileged information
(POS) Point-of Service Plan
Claim
33. Health Information Portability and Accountability Act
HIPAA
ethics
Allowed Expenses
cash flow
34. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Assignment & Authorization
disclosure
Out of Network (OON)
ordering physician
35. A willful act by an employee of taking possession of an employer's money
clearinghouse
(ERISA) Employee Retirement Income Security Act of 1974
Treating or performing physician
Embezzlement
36. 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
(OOPs) Out of Pocket Costs/Expenses
Experimental Procedures
(DME) Durable Medical Equipment
(ERISA) Employee Retirement Income Security Act of 1974
37. Unauthorized release of information
IIHI
(DCI) Duplicate Coverage Inquiry
breach of confidential communication
Maximum Out Of Pocket
38. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(DRG's)
Assignment & Authorization
(EPO) Exclusive Provider Organization
Protected health information
39. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
subscriber
Pre-existing Condition Exclusion
business associate
referral
40. A nonprofit integrated delivery system
pos
HIPAA
medical foundation
Preauthorization
41. A structure for classifying outpatient services and procedures for purpose of payment
Covered Expenses
(APC) Ambulatory Patient Classifications
abuse
closed panel HMO
42. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
Privileged information
Covered Expenses
AMA
43. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Privileged information
referral
hmo
e-health information management
44. Verbal or written agreement that gives approval to some action - situation - or statement.
(PEC) Pre-existing condition
(AOB) Assignment of Benefits
consent
privacy
45. Unauthorized release of information
preauthorization
breach of confidential communication
epo
(APC) Ambulatory Patient Classifications
46. 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
attending physician
Protected health information
(POS) Point-of Service Plan
Experimental Procedures
47. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Open Enrollment
(POS) Point-of Service Plan
hmo
Covered Expenses
48. 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
(DME) Durable Medical Equipment
Network
Specialist
(UR) Utilization review
49. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(DRG's)
complience
authorization form
consulting physician
50. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Out of Network (OON)
(EPO) Exclusive Provider Organization
Deductible