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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. The maximum amount a plan pays for a covered service
Consent form
authorization form
Allowed Expenses
ethics
2. 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
consulting physician
premium
Pre-certification
3. 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
ppo
Assignment & Authorization
pos
claim
4. 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
IIHI
Allowed Expenses
medical foundation
5. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
pos
electronic media
phantom billing
(DOS) Date of Service
6. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
clearinghouse
abuse
Beneficiary
complience plan
7. Unauthorized release of information
(OOPs) Out of Pocket Costs/Expenses
breach of confidential communication
clearinghouse
benefit period
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
Referral
nonprivileged information
attending physician
pcp
9. 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.
Privileged information
Deductible
Consent form
(PCP) Primary Care Physician
10. 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
Maximum Out Of Pocket
referring physician
(ABN) Advance Beneficiary Notice
11. 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.
Privacy officer
(PAC) Pre- Admission Certification
medical foundation
AMA
12. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
pos
cash flow
(UCR) Usual - Customary and Reasonable
preauthorization
13. Unauthorized release of information
(Non-par) Non-Participating Provider
(EPO) Exclusive Provider Organization
claim
breach of confidential communication
14. 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
disclosure
(COBRA)
open panel HMO
phantom billing
15. 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
Resonable Charge
econdary Payer
(DCI) Duplicate Coverage Inquiry
16. A list of the amount to be paid by an insurance company for each procedure service
econdary Payer
ee schedule
Protected health information
Pre-existing Condition Exclusion
17. 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
(UCR) Usual - Customary and Reasonable
claim
Standard
(COBRA)
18. 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
ids
epo
Embezzlement
Treating or performing physician
19. 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
referring physician
Network
consent
Maximum Out Of Pocket
20. 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
Notice of Privacy Practices
econdary Payer
(OOPs) Out of Pocket Costs/Expenses
21. 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.
preauthorization
Protected health information
Network
Privileged information
22. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(ERISA) Employee Retirement Income Security Act of 1974
business associate
clearinghouse
phantom billing
23. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
Maximum Out Of Pocket
(UR) Utilization review
authorization form
24. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(UR) Utilization review
security officer
transaction
Network
25. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
consent
covered entity
breach of confidential communication
(UCR) Usual - Customary and Reasonable
26. 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.
self-referral
(Non-par) Non-Participating Provider
Notice of Privacy Practices
Beneficiary
27. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
deductible
Pre-certification
ordering physician
28. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Open Enrollment
(PEC) Pre-existing condition
(UR) Utilization review
(PCN) Primary Care Network
29. 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
ordering physician
electronic media
closed panel HMO
(PCN) Primary Care Network
30. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
state preemption
Covered Expenses
pcp
econdary Payer
31. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Beneficiary
etiquette
business associate
Referral
32. 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
pos
(UR) Utilization review
Privileged information
state preemption
33. 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
business associate
closed panel HMO
Notice of Privacy Practices
34. 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
ordering physician
Embezzlement
Subscriber
35. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(DME) Durable Medical Equipment
health care provider
etiquette
36. An organization of provider sites with a contracted relationship that offer services
Network
(PAC) Pre- Admission Certification
epo
ids
37. Health Information Portability and Accountability Act
Embezzlement
security officer
business associate
HIPAA
38. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
fraud
confidentiality
Resonable Charge
39. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Claim
ids
Participating Provider
(UCR) Usual - Customary and Reasonable
40. American Medical Association
HIPAA
Individually identifiable health information
referral
AMA
41. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
disclosure
(EPO) Exclusive Provider Organization
Maximum Out Of Pocket
42. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Deductible
nonprivileged information
consulting physician
Open Enrollment
43. The period of time that payment for Medicare inpatient hospital benefits are available
Notice of Privacy Practices
complience
pos
benefit period
44. Standards of conduct generally accepted as a moral guide for behavior.
ethics
Participating Provider
complience plan
(DRG's)
45. 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)
referring physician
deductible
crossover claim
Consent form
46. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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47. 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
(OOPs) Out of Pocket Costs/Expenses
Out of Network (OON)
closed panel HMO
transaction
48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
(ERISA) Employee Retirement Income Security Act of 1974
prepaid plan
(AOB) Assignment of Benefits
49. 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
Amblatory Care
Privacy officer
Referral
ppo
50. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Resonable Charge
(DCI) Duplicate Coverage Inquiry
e-health information management
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