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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. Verbal or written agreement that gives approval to some action - situation - or statement.
(UR) Utilization review
consent
Pre-existing Condition Exclusion
crossover claim
2. An intentional misrepresentation of the facts to deceive or mislead another.
Deductible
(COB) Coordination of Benefits
Experimental Procedures
fraud
3. Is a provider who sends the patients for testing or treatment
referring physician
confidentiality
Open Enrollment
Resonable Charge
4. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
hmo
Allowed Expenses
Specialist
5. 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
Covered Expenses
etiquette
(DME) Durable Medical Equipment
6. 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
ee schedule
Out of Network (OON)
breach of confidential communication
prepaid plan
7. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Embezzlement
ordering physician
(PPS) Hospital Impatient Prospective Payment System
Covered Expenses
8. 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
Confidential communication
Network
nonprivileged information
(DME) Durable Medical Equipment
9. Unauthorized release of information
Pre-certification
breach of confidential communication
(COB) Coordination of Benefits
disclosure
10. 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
(DOS) Date of Service
Pre-existing Condition Exclusion
IIHI
covered entity
11. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
consulting physician
(PCN) Primary Care Network
medical foundation
12. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
(AOB) Assignment of Benefits
referring physician
Embezzlement
13. 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
Allowed Expenses
complience plan
Supplementary Medical Insurance
(POS) Point-of Service Plan
14. 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.
cash flow
Claim
(Non-par) Non-Participating Provider
Privacy officer
15. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
confidentiality
complience plan
covered entity
16. 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.
ppo
Subscriber
state preemption
health care provider
17. The transmission of information between two parties to carry out financial or administrative activities related to health care.
phantom billing
transaction
deductible
privacy
18. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Treating or performing physician
consulting physician
epo
business associate
19. 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
Preauthorization
deductible
abuse
breach of confidential communication
20. 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
pos
(POS) Point-of Service Plan
Resonable Charge
Security Rule
21. 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.
Beneficiary
(OOPs) Out of Pocket Costs/Expenses
Privacy officer
nonprivileged information
22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(PPS) Hospital Impatient Prospective Payment System
(APC) Ambulatory Patient Classifications
abuse
Resonable Charge
23. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
phantom billing
covered entity
security officer
complience
24. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
privacy
preauthorization
nonprivileged information
(PEC) Pre-existing condition
25. 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
Standard
(COB) Coordination of Benefits
ppo
confidentiality
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
authorization form
(DRG's)
medical foundation
disclosure
27. 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
deductible
(PCN) Primary Care Network
Notice of Privacy Practices
fraud
28. 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
attending physician
Experimental Procedures
(DOS) Date of Service
Allowed Expenses
29. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
open panel HMO
Network
subscriber
IIHI
30. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
ppo
Subscriber
(DME) Durable Medical Equipment
complience plan
31. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
abuse
clearinghouse
premium
econdary Payer
32. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(DRG's)
Pre-existing Condition Exclusion
Coordinated Coverage
(TPA) Third Party Administrator
33. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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34. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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35. Is the provider who renders a service to a patient
premium
referring physician
claim
Treating or performing physician
36. 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
(AOB) Assignment of Benefits
Claim
referral
Experimental Procedures
37. The maximum amount a plan pays for a covered service
Allowed Expenses
Treating or performing physician
claim
security officer
38. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
transaction
Pre-existing Condition Exclusion
(TPA) Third Party Administrator
Resonable Charge
39. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
crossover claim
(OOPs) Out of Pocket Costs/Expenses
(TPA) Third Party Administrator
40. 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.
(TPA) Third Party Administrator
health care provider
Individually identifiable health information
confidentiality
41. 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.
abuse
Privacy officer
(DRG's)
health care provider
42. 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
Individually identifiable health information
(COBRA)
nonprivileged information
(PAC) Pre- Admission Certification
43. A patient claim is eligible for medicare and medicaid
confidentiality
deductible
(POS) Point-of Service Plan
crossover claim
44. 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.
attending physician
business associate
hmo
(EPO) Exclusive Provider Organization
45. Integrating benefits payable under more than one health insurance.
(ERISA) Employee Retirement Income Security Act of 1974
(COB) Coordination of Benefits
Coordinated Coverage
ordering physician
46. The period of time that payment for Medicare inpatient hospital benefits are available
Resonable Charge
benefit period
Amblatory Care
consulting physician
47. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Subscriber
referral
Standard
confidentiality
48. Approval or consent by a primary physician for patient referral to ancillary services and specialists
HIPAA
Referral
Amblatory Care
Beneficiary
49. The dates of healthcare services were provided to the beneficiary
(DRG's)
Specialist
self-referral
(DOS) Date of Service
50. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
etiquette
referral
(DOS) Date of Service
hmo