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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. 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
attending physician
authorization form
(ERISA) Employee Retirement Income Security Act of 1974
(ABN) Advance Beneficiary Notice
2. A list of the amount to be paid by an insurance company for each procedure service
Assignment & Authorization
(DOS) Date of Service
(COBRA)
ee schedule
3. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
(PPS) Hospital Impatient Prospective Payment System
claim
ids
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
pos
Resonable Charge
pcp
consent
5. 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.
clearinghouse
Allowed Expenses
Privacy officer
closed panel HMO
6. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
closed panel HMO
Beneficiary
ethics
(EPO) Exclusive Provider Organization
7. 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
Open Enrollment
nonprivileged information
(POS) Point-of Service Plan
pos
8. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
(DOS) Date of Service
(COB) Coordination of Benefits
attending physician
9. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
ordering physician
benefit period
(PAC) Pre- Admission Certification
10. Billing for services not performed
covered entity
claim
Treating or performing physician
phantom billing
11. Medical services provided on an outpatient basis
Experimental Procedures
(Non-par) Non-Participating Provider
Amblatory Care
Preauthorization
12. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
open panel HMO
transaction
deductible
(AOB) Assignment of Benefits
13. A monthly fee paid by the insured for specific medical insurance coverage
premium
Referral
(OOPs) Out of Pocket Costs/Expenses
(ERISA) Employee Retirement Income Security Act of 1974
14. 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
hmo
privacy
ppo
(POS) Point-of Service Plan
15. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(ERISA) Employee Retirement Income Security Act of 1974
Deductible
Embezzlement
(DCI) Duplicate Coverage Inquiry
16. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(ABN) Advance Beneficiary Notice
consent
Consent form
claim
17. Unauthorized release of information
ppo
breach of confidential communication
Privacy officer
complience
18. Is a provider who sends the patients for testing or treatment
prepaid plan
(PPS) Hospital Impatient Prospective Payment System
referring physician
Allowed Expenses
19. 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
Maximum Out Of Pocket
Participating Provider
Embezzlement
Medigap Insurance
20. Verbal or written agreement that gives approval to some action - situation - or statement.
(DOS) Date of Service
self-referral
referral
consent
21. An intentional misrepresentation of the facts to deceive or mislead another.
electronic media
fraud
Confidential communication
Covered Expenses
22. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(TPA) Third Party Administrator
Individually identifiable health information
ordering physician
Preauthorization
23. 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
Deductible
fraud
security officer
Allowed Expenses
24. 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
(ERISA) Employee Retirement Income Security Act of 1974
econdary Payer
Protected health information
Treating or performing physician
25. 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
AMA
Claim
(PEC) Pre-existing condition
Sub-acute Care
26. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Out of Network (OON)
Experimental Procedures
(PEC) Pre-existing condition
Open Enrollment
27. 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.
health care provider
Deductible
Supplementary Medical Insurance
consulting physician
28. A review of the need for inpatient hospital care - completed before the actual admission
closed panel HMO
business associate
(PAC) Pre- Admission Certification
Medigap Insurance
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
Subscriber
e-health information management
referring physician
Maximum Out Of Pocket
30. The dates of healthcare services were provided to the beneficiary
complience
abuse
(DOS) Date of Service
ee schedule
31. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
open panel HMO
(PEC) Pre-existing condition
phantom billing
(UCR) Usual - Customary and Reasonable
32. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Assignment & Authorization
pcp
breach of confidential communication
referring physician
33. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(PCN) Primary Care Network
hmo
Participating Provider
fraud
34. 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
econdary Payer
(PEC) Pre-existing condition
(Non-par) Non-Participating Provider
(ERISA) Employee Retirement Income Security Act of 1974
35. 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
Assignment & Authorization
Referral
(AOB) Assignment of Benefits
confidentiality
36. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
Medigap Insurance
hmo
Security Rule
37. 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.
medical foundation
ids
business associate
(PAC) Pre- Admission Certification
38. 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
nonprivileged information
(Non-par) Non-Participating Provider
Medigap Insurance
Supplementary Medical Insurance
39. A privileged communication that may be disclosed only with the patient's permission.
consulting physician
Confidential communication
consent
(DRG's)
40. The condition of being secluded from the presence or view of others.
benefit period
complience plan
Sub-acute Care
privacy
41. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(COBRA)
(DME) Durable Medical Equipment
Referral
(ABN) Advance Beneficiary Notice
42. Individually identifiable health information
IIHI
Security Rule
ids
Privileged information
43. 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
clearinghouse
preauthorization
(DCI) Duplicate Coverage Inquiry
44. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(DME) Durable Medical Equipment
clearinghouse
electronic media
Allowed Expenses
45. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
e-health information management
Individually identifiable health information
(ERISA) Employee Retirement Income Security Act of 1974
Medigap Insurance
46. 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.
Covered Expenses
(UCR) Usual - Customary and Reasonable
(EPO) Exclusive Provider Organization
Privileged information
47. 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
(PCP) Primary Care Physician
subscriber
(OOPs) Out of Pocket Costs/Expenses
48. 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
(PPS) Hospital Impatient Prospective Payment System
Assignment & Authorization
etiquette
(AOB) Assignment of Benefits
49. 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
state preemption
Assignment & Authorization
etiquette
pos
50. Integrating benefits payable under more than one health insurance.
epo
etiquette
premium
Coordinated Coverage