SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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. Is the provider who renders a service to a patient
Confidential communication
preauthorization
clearinghouse
Treating or performing physician
2. 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.
business associate
Notice of Privacy Practices
Maximum Out Of Pocket
Resonable Charge
3. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Privileged information
(TPA) Third Party Administrator
Open Enrollment
breach of confidential communication
4. 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
Referral
claim
(APC) Ambulatory Patient Classifications
5. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
ee schedule
(UCR) Usual - Customary and Reasonable
Claim
referral
6. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(Non-par) Non-Participating Provider
phantom billing
Resonable Charge
Participating Provider
7. 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
prepaid plan
abuse
open panel HMO
Claim
8. 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
Experimental Procedures
Out of Network (OON)
clearinghouse
Covered Expenses
9. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
privacy
transaction
nonprivileged information
10. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Specialist
e-health information management
phantom billing
(UR) Utilization review
11. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
state preemption
Subscriber
pcp
preauthorization
12. A review of the need for inpatient hospital care - completed before the actual admission
Open Enrollment
covered entity
Assignment & Authorization
(PAC) Pre- Admission Certification
13. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(PEC) Pre-existing condition
(UCR) Usual - Customary and Reasonable
complience
14. 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
security officer
open panel HMO
Maximum Out Of Pocket
Maximum Out Of Pocket
15. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
self-referral
disclosure
Pre-certification
Privileged information
16. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(DRG's)
HIPAA
hmo
(Non-par) Non-Participating Provider
17. 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
(PCP) Primary Care Physician
abuse
ids
Experimental Procedures
18. 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.
Beneficiary
Preauthorization
Privileged information
fraud
19. Medical staff member who is legally responsible for the care and treatment given to a patient.
disclosure
AMA
attending physician
crossover claim
20. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
Individually identifiable health information
epo
ids
21. The period of time that payment for Medicare inpatient hospital benefits are available
(PCN) Primary Care Network
abuse
(DCI) Duplicate Coverage Inquiry
benefit period
22. Billing for services not performed
deductible
authorization form
Pre-existing Condition Exclusion
phantom billing
23. Medical staff member who is legally responsible for the care and treatment given to a patient.
ordering physician
(DRG's)
Pre-certification
attending physician
24. 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
(PEC) Pre-existing condition
Participating Provider
Out of Network (OON)
(OOPs) Out of Pocket Costs/Expenses
25. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
Medigap Insurance
(UR) Utilization review
Notice of Privacy Practices
26. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
cash flow
e-health information management
(DRG's)
27. 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.
complience plan
pos
state preemption
(APC) Ambulatory Patient Classifications
28. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
Warning
: Invalid argument supplied for foreach() in
/var/www/html/basicversity.com/show_quiz.php
on line
183
29. A patient claim is eligible for medicare and medicaid
subscriber
(TPA) Third Party Administrator
ordering physician
crossover claim
30. 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
phantom billing
electronic media
breach of confidential communication
Participating Provider
31. 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
open panel HMO
referring physician
pos
e-health information management
32. The amount of actual money available to the medical practice
phantom billing
ethics
(DOS) Date of Service
cash flow
33. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Consent form
Pre-existing Condition Exclusion
claim
confidentiality
34. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
referring physician
Medigap Insurance
consulting physician
ids
35. Standards of conduct generally accepted as a moral guide for behavior.
(OOPs) Out of Pocket Costs/Expenses
Sub-acute Care
ethics
Pre-certification
36. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
(APC) Ambulatory Patient Classifications
Amblatory Care
Out of Network (OON)
37. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Sub-acute Care
complience
self-referral
(PEC) Pre-existing condition
38. 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
Specialist
cash flow
fraud
(PCP) Primary Care Physician
39. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
health care provider
pos
referral
security officer
40. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
ordering physician
hmo
prepaid plan
41. Is the provider who renders a service to a patient
Supplementary Medical Insurance
Protected health information
Embezzlement
Treating or performing physician
42. 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
consulting physician
epo
(ABN) Advance Beneficiary Notice
43. 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
nonprivileged information
privacy
Supplementary Medical Insurance
Maximum Out Of Pocket
44. What the insurance company will consider paying for as defined in the contract.
Out of Network (OON)
pcp
Covered Expenses
ordering physician
45. Health Information Portability and Accountability Act
HIPAA
security officer
consulting physician
(DCI) Duplicate Coverage Inquiry
46. 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
Subscriber
Experimental Procedures
(PPS) Hospital Impatient Prospective Payment System
epo
47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Consent form
pcp
(PCP) Primary Care Physician
Sub-acute Care
48. 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
e-health information management
(Non-par) Non-Participating Provider
e-health information management
Claim
49. An intentional misrepresentation of the facts to deceive or mislead another.
authorization form
Experimental Procedures
fraud
(UR) Utilization review
50. Approval or consent by a primary physician for patient referral to ancillary services and specialists
IIHI
claim
Referral
privacy