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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. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
attending physician
disclosure
Medigap Insurance
Covered Expenses
2. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
pos
(TPA) Third Party Administrator
Privacy officer
Covered Expenses
3. 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.
Maximum Out Of Pocket
state preemption
(DOS) Date of Service
(ABN) Advance Beneficiary Notice
4. 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
(PCP) Primary Care Physician
Resonable Charge
authorization form
Out of Network (OON)
5. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
etiquette
security officer
Consent form
6. Medical services provided on an outpatient basis
(PCP) Primary Care Physician
Amblatory Care
state preemption
Resonable Charge
7. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
consent
claim
complience
(PCN) Primary Care Network
8. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(OOPs) Out of Pocket Costs/Expenses
(DCI) Duplicate Coverage Inquiry
Standard
Security Rule
9. 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
Coordinated Coverage
attending physician
prepaid plan
medical foundation
10. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
ppo
Subscriber
abuse
privacy
11. 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
state preemption
Preauthorization
subscriber
12. A monthly fee paid by the insured for specific medical insurance coverage
premium
Privileged information
etiquette
nonprivileged information
13. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
(EPO) Exclusive Provider Organization
(ABN) Advance Beneficiary Notice
hmo
14. 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
Claim
(ERISA) Employee Retirement Income Security Act of 1974
authorization form
prepaid plan
15. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
ordering physician
Privacy officer
Coordinated Coverage
16. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(ERISA) Employee Retirement Income Security Act of 1974
ordering physician
(AOB) Assignment of Benefits
17. 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
(ERISA) Employee Retirement Income Security Act of 1974
e-health information management
Security Rule
18. Standards of conduct generally accepted as a moral guide for behavior.
Security Rule
Privacy officer
ethics
Open Enrollment
19. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
subscriber
(UR) Utilization review
complience plan
authorization form
20. 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
(ERISA) Employee Retirement Income Security Act of 1974
ethics
Deductible
Preauthorization
21. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
ee schedule
(PCP) Primary Care Physician
(COB) Coordination of Benefits
22. Integrating benefits payable under more than one health insurance.
(ERISA) Employee Retirement Income Security Act of 1974
Coordinated Coverage
abuse
(ABN) Advance Beneficiary Notice
23. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
Privacy officer
Resonable Charge
medical foundation
24. 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.
cash flow
business associate
(Non-par) Non-Participating Provider
Preauthorization
25. 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
IIHI
clearinghouse
(PCP) Primary Care Physician
ee schedule
26. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
breach of confidential communication
deductible
(PPS) Hospital Impatient Prospective Payment System
Covered Expenses
27. 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
(ERISA) Employee Retirement Income Security Act of 1974
authorization form
Assignment & Authorization
open panel HMO
28. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
authorization form
referral
(COB) Coordination of Benefits
preauthorization
29. 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
ppo
(PPS) Hospital Impatient Prospective Payment System
Pre-certification
(TPA) Third Party Administrator
30. A rule - condition - or requirement
prepaid plan
Privileged information
Standard
(PCN) Primary Care Network
31. 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.
security officer
Sub-acute Care
econdary Payer
complience
32. 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
Security Rule
Referral
medical foundation
Consent form
33. The period of time that payment for Medicare inpatient hospital benefits are available
Individually identifiable health information
benefit period
(AOB) Assignment of Benefits
Medigap Insurance
34. A willful act by an employee of taking possession of an employer's money
consulting physician
(PAC) Pre- Admission Certification
Embezzlement
(DRG's)
35. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
closed panel HMO
Pre-certification
subscriber
Assignment & Authorization
36. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(PAC) Pre- Admission Certification
confidentiality
ordering physician
Beneficiary
37. Medical staff member who is legally responsible for the care and treatment given to a patient.
Experimental Procedures
disclosure
attending physician
Pre-existing Condition Exclusion
38. Standards of conduct generally accepted as a moral guide for behavior.
subscriber
ethics
(ABN) Advance Beneficiary Notice
(DRG's)
39. An intentional misrepresentation of the facts to deceive or mislead another.
subscriber
(PCP) Primary Care Physician
(TPA) Third Party Administrator
fraud
40. The dates of healthcare services were provided to the beneficiary
Preauthorization
ee schedule
(DOS) Date of Service
Sub-acute Care
41. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
referring physician
closed panel HMO
Claim
42. Medicare's method of paying acute care hospitals for inpatient care
AMA
ppo
subscriber
(PPS) Hospital Impatient Prospective Payment System
43. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
complience
etiquette
Medigap Insurance
44. 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
Privileged information
consulting physician
Privacy officer
45. The maximum amount a plan pays for a covered service
Individually identifiable health information
ordering physician
e-health information management
Allowed Expenses
46. American Medical Association
AMA
phantom billing
electronic media
IIHI
47. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
transaction
Assignment & Authorization
medical foundation
referral
48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Pre-existing Condition Exclusion
Pre-certification
health care provider
abuse
49. A nonprofit integrated delivery system
Beneficiary
abuse
medical foundation
state preemption
50. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Consent form
Deductible
pcp