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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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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. 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
Individually identifiable health information
etiquette
Out of Network (OON)
Pre-certification
2. The condition of being secluded from the presence or view of others.
privacy
(PCN) Primary Care Network
closed panel HMO
(UCR) Usual - Customary and Reasonable
3. A list of the amount to be paid by an insurance company for each procedure service
Out of Network (OON)
Confidential communication
Experimental Procedures
ee schedule
4. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
(COBRA)
Protected health information
(UR) Utilization review
covered entity
5. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(OOPs) Out of Pocket Costs/Expenses
Open Enrollment
electronic media
(POS) Point-of Service Plan
6. A provision that apples when a person is covered under more than one group medical program
Pre-existing Condition Exclusion
business associate
(COB) Coordination of Benefits
state preemption
7. A willful act by an employee of taking possession of an employer's money
Embezzlement
state preemption
econdary Payer
Privileged information
8. The amount of actual money available to the medical practice
(ABN) Advance Beneficiary Notice
ids
cash flow
Pre-certification
9. Individually identifiable health information
claim
IIHI
consulting physician
Pre-existing Condition Exclusion
10. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Individually identifiable health information
claim
fraud
11. 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
ppo
Supplementary Medical Insurance
Security Rule
Covered Expenses
12. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
Allowed Expenses
Protected health information
Treating or performing physician
(PPS) Hospital Impatient Prospective Payment System
13. 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
(PCP) Primary Care Physician
benefit period
Assignment & Authorization
(PEC) Pre-existing condition
14. The maximum amount a plan pays for a covered service
Out of Network (OON)
Allowed Expenses
covered entity
(COB) Coordination of Benefits
15. Customs - rules of conduct - courtesy - and manners of the medical profession
(DRG's)
etiquette
(APC) Ambulatory Patient Classifications
covered entity
16. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(PPS) Hospital Impatient Prospective Payment System
(AOB) Assignment of Benefits
(OOPs) Out of Pocket Costs/Expenses
abuse
17. An intentional misrepresentation of the facts to deceive or mislead another.
(POS) Point-of Service Plan
(Non-par) Non-Participating Provider
fraud
benefit period
18. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
state preemption
Beneficiary
(TPA) Third Party Administrator
referral
19. 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
benefit period
Out of Network (OON)
Claim
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)
etiquette
(DCI) Duplicate Coverage Inquiry
Consent form
(OOPs) Out of Pocket Costs/Expenses
21. 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
Pre-existing Condition Exclusion
e-health information management
business associate
(PCN) Primary Care Network
22. 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
epo
Confidential communication
Out of Network (OON)
ppo
23. A nonprofit integrated delivery system
benefit period
(TPA) Third Party Administrator
referring physician
medical foundation
24. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
pos
consulting physician
health care provider
(UR) Utilization review
25. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
Beneficiary
Privileged information
phantom billing
Protected health information
26. 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
ee schedule
authorization form
Maximum Out Of Pocket
business associate
27. 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
Privileged information
claim
Covered Expenses
28. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
(AOB) Assignment of Benefits
Covered Expenses
premium
29. 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
(PPS) Hospital Impatient Prospective Payment System
privacy
Participating Provider
(Non-par) Non-Participating Provider
30. A willful act by an employee of taking possession of an employer's money
Embezzlement
Confidential communication
authorization form
Amblatory Care
31. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
self-referral
pcp
consulting physician
32. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Participating Provider
hmo
Open Enrollment
(ERISA) Employee Retirement Income Security Act of 1974
33. Is the provider who renders a service to a patient
(EPO) Exclusive Provider Organization
attending physician
disclosure
Treating or performing physician
34. 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
phantom billing
Supplementary Medical Insurance
Pre-existing Condition Exclusion
(COBRA)
35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
preauthorization
Consent form
prepaid plan
(OOPs) Out of Pocket Costs/Expenses
36. 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.
referring physician
epo
health care provider
Allowed Expenses
37. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
disclosure
(TPA) Third Party Administrator
Claim
open panel HMO
38. Standards of conduct generally accepted as a moral guide for behavior.
referring physician
state preemption
consent
ethics
39. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
Out of Network (OON)
Preauthorization
prepaid plan
Supplementary Medical Insurance
40. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
nonprivileged information
Medigap Insurance
authorization form
medical foundation
41. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DRG's)
Covered Expenses
Medigap Insurance
ppo
42. 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
referring physician
(Non-par) Non-Participating Provider
premium
consulting physician
43. Someone who is eligible for or receiving benefits under an insurance policy or plan
subscriber
Referral
preauthorization
Beneficiary
44. 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
hmo
Supplementary Medical Insurance
complience plan
(COBRA)
45. A provision that apples when a person is covered under more than one group medical program
abuse
crossover claim
(COB) Coordination of Benefits
Medigap Insurance
46. Integrating benefits payable under more than one health insurance.
clearinghouse
fraud
Coordinated Coverage
Covered Expenses
47. 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.
Supplementary Medical Insurance
Notice of Privacy Practices
Individually identifiable health information
ordering physician
48. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Preauthorization
referring physician
confidentiality
(DRG's)
49. A clinic that is owned by the HMO and the physicians are employees of the HMO
Beneficiary
closed panel HMO
security officer
(ERISA) Employee Retirement Income Security Act of 1974
50. 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
Assignment & Authorization
ordering physician
closed panel HMO
Preauthorization