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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. 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
attending physician
(COBRA)
Sub-acute Care
2. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
fraud
consent
benefit period
Medigap Insurance
3. A list of the amount to be paid by an insurance company for each procedure service
(DOS) Date of Service
ee schedule
ethics
hmo
4. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
econdary Payer
pos
hmo
state preemption
5. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Amblatory Care
(EPO) Exclusive Provider Organization
subscriber
(COB) Coordination of Benefits
6. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
medical foundation
complience
consulting physician
(UCR) Usual - Customary and Reasonable
7. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
state preemption
(PEC) Pre-existing condition
open panel HMO
(TPA) Third Party Administrator
8. 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.
cash flow
Protected health information
Claim
Referral
9. 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
Participating Provider
cash flow
AMA
(AOB) Assignment of Benefits
10. 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)
Consent form
pos
Individually identifiable health information
Notice of Privacy Practices
11. 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
(PCP) Primary Care Physician
epo
ids
IIHI
12. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
Sub-acute Care
ppo
ordering physician
Amblatory Care
13. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
ee schedule
(ABN) Advance Beneficiary Notice
(APC) Ambulatory Patient Classifications
14. An organization of provider sites with a contracted relationship that offer services
Pre-certification
(COBRA)
privacy
ids
15. A provision that apples when a person is covered under more than one group medical program
hmo
(COB) Coordination of Benefits
(DRG's)
(DCI) Duplicate Coverage Inquiry
16. 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
Privileged information
HIPAA
complience plan
Open Enrollment
17. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
ids
(PCP) Primary Care Physician
security officer
pcp
18. 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
attending physician
ppo
Security Rule
Pre-existing Condition Exclusion
19. 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
nonprivileged information
Notice of Privacy Practices
Individually identifiable health information
Pre-existing Condition Exclusion
20. 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
(Non-par) Non-Participating Provider
subscriber
Specialist
(OOPs) Out of Pocket Costs/Expenses
21. Individually identifiable health information
IIHI
ids
business associate
confidentiality
22. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
AMA
(OOPs) Out of Pocket Costs/Expenses
subscriber
pcp
23. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
ordering physician
(ABN) Advance Beneficiary Notice
covered entity
24. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
attending physician
IIHI
e-health information management
25. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
self-referral
Medigap Insurance
Maximum Out Of Pocket
prepaid plan
26. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
etiquette
ppo
etiquette
27. A rule - condition - or requirement
Amblatory Care
pcp
Standard
Resonable Charge
28. Verbal or written agreement that gives approval to some action - situation - or statement.
privacy
consent
Preauthorization
(AOB) Assignment of Benefits
29. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
breach of confidential communication
(DRG's)
pcp
30. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Claim
Network
ordering physician
electronic media
31. Medical staff member who is legally responsible for the care and treatment given to a patient.
pos
Assignment & Authorization
attending physician
subscriber
32. 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.
ppo
medical foundation
health care provider
(UR) Utilization review
33. 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
Resonable Charge
breach of confidential communication
authorization form
34. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
pcp
Allowed Expenses
Specialist
deductible
35. An intentional misrepresentation of the facts to deceive or mislead another.
(PCN) Primary Care Network
consulting physician
benefit period
fraud
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
cash flow
(AOB) Assignment of Benefits
referral
Privacy officer
37. A structure for classifying outpatient services and procedures for purpose of payment
(COB) Coordination of Benefits
Resonable Charge
(APC) Ambulatory Patient Classifications
(UR) Utilization review
38. 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
consulting physician
Open Enrollment
Protected health information
authorization form
39. Customs - rules of conduct - courtesy - and manners of the medical profession
Sub-acute Care
Network
etiquette
nonprivileged information
40. 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
consent
subscriber
covered entity
electronic media
41. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(ERISA) Employee Retirement Income Security Act of 1974
consulting physician
Specialist
etiquette
42. Integrating benefits payable under more than one health insurance.
deductible
Coordinated Coverage
Medigap Insurance
(PAC) Pre- Admission Certification
43. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(PEC) Pre-existing condition
prepaid plan
disclosure
Assignment & Authorization
44. A nonprofit integrated delivery system
ids
medical foundation
complience plan
Resonable Charge
45. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Deductible
subscriber
(EPO) Exclusive Provider Organization
(DRG's)
46. 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
(AOB) Assignment of Benefits
Individually identifiable health information
Treating or performing physician
47. A patient claim is eligible for medicare and medicaid
self-referral
nonprivileged information
crossover claim
(DOS) Date of Service
48. The amount of actual money available to the medical practice
cash flow
Open Enrollment
ethics
Standard
49. 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.
health care provider
business associate
preauthorization
consent
50. Customs - rules of conduct - courtesy - and manners of the medical profession
Consent form
covered entity
premium
etiquette
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