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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 member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Covered Expenses
Resonable Charge
subscriber
electronic media
2. A nonprofit integrated delivery system
Coordinated Coverage
medical foundation
transaction
(PAC) Pre- Admission Certification
3. 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
Embezzlement
covered entity
complience plan
(COBRA)
4. The amount of actual money available to the medical practice
(COB) Coordination of Benefits
Allowed Expenses
Privileged information
cash flow
5. Is a provider who sends the patients for testing or treatment
referring physician
prepaid plan
Protected health information
Open Enrollment
6. A list of the amount to be paid by an insurance company for each procedure service
(TPA) Third Party Administrator
Assignment & Authorization
ee schedule
Pre-existing Condition Exclusion
7. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
premium
benefit period
nonprivileged information
8. 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
covered entity
pcp
disclosure
Experimental Procedures
9. Someone who is eligible for or receiving benefits under an insurance policy or plan
consent
(DOS) Date of Service
Beneficiary
fraud
10. 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
covered entity
epo
Deductible
11. 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
Preauthorization
Security Rule
ppo
epo
12. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
premium
state preemption
Coordinated Coverage
Specialist
13. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Standard
business associate
Beneficiary
(DCI) Duplicate Coverage Inquiry
14. Customs - rules of conduct - courtesy - and manners of the medical profession
closed panel HMO
Subscriber
etiquette
(DCI) Duplicate Coverage Inquiry
15. 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
AMA
claim
Supplementary Medical Insurance
(ABN) Advance Beneficiary Notice
16. 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
AMA
covered entity
electronic media
(AOB) Assignment of Benefits
17. A privileged communication that may be disclosed only with the patient's permission.
Deductible
(PAC) Pre- Admission Certification
Confidential communication
(POS) Point-of Service Plan
18. 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
(UR) Utilization review
e-health information management
(Non-par) Non-Participating Provider
19. What the insurance company will consider paying for as defined in the contract.
deductible
benefit period
referring physician
Covered Expenses
20. 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
(PCP) Primary Care Physician
Pre-certification
prepaid plan
Security Rule
21. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
fraud
Sub-acute Care
(DME) Durable Medical Equipment
22. Individually identifiable health information
premium
Amblatory Care
IIHI
(OOPs) Out of Pocket Costs/Expenses
23. 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
Beneficiary
Assignment & Authorization
econdary Payer
Claim
24. 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
health care provider
Preauthorization
Subscriber
nonprivileged information
25. 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.
Notice of Privacy Practices
Resonable Charge
Amblatory Care
health care provider
26. An organization of provider sites with a contracted relationship that offer services
benefit period
Privileged information
disclosure
ids
27. 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
AMA
(OOPs) Out of Pocket Costs/Expenses
(EPO) Exclusive Provider Organization
econdary Payer
28. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Resonable Charge
(POS) Point-of Service Plan
fraud
(PEC) Pre-existing condition
29. 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.
Out of Network (OON)
state preemption
Preauthorization
Network
30. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
hmo
Deductible
clearinghouse
consulting physician
31. The transmission of information between two parties to carry out financial or administrative activities related to health care.
epo
e-health information management
transaction
health care provider
32. 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
Assignment & Authorization
consulting physician
(POS) Point-of Service Plan
(DCI) Duplicate Coverage Inquiry
33. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
pcp
(DOS) Date of Service
Amblatory Care
34. 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.
hmo
Privileged information
cash flow
etiquette
35. Approval or consent by a primary physician for patient referral to ancillary services and specialists
abuse
Referral
Individually identifiable health information
Subscriber
36. 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)
Assignment & Authorization
Consent form
privacy
crossover claim
37. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
referring physician
epo
complience plan
Pre-certification
38. 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.
open panel HMO
Notice of Privacy Practices
e-health information management
Privacy officer
39. 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
pcp
(AOB) Assignment of Benefits
Subscriber
40. Is the provider who renders a service to a patient
Treating or performing physician
Consent form
Individually identifiable health information
confidentiality
41. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
security officer
business associate
confidentiality
42. 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
self-referral
ppo
Maximum Out Of Pocket
Participating Provider
43. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
ethics
Open Enrollment
state preemption
(COBRA)
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
nonprivileged information
transaction
open panel HMO
45. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(UCR) Usual - Customary and Reasonable
complience plan
Specialist
cash flow
46. 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
Resonable Charge
(COBRA)
Security Rule
Experimental Procedures
47. 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
Medigap Insurance
Referral
consent
48. 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
state preemption
e-health information management
(APC) Ambulatory Patient Classifications
49. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(APC) Ambulatory Patient Classifications
(OOPs) Out of Pocket Costs/Expenses
(AOB) Assignment of Benefits
Sub-acute Care
50. 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
phantom billing
Assignment & Authorization
complience
Experimental Procedures