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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.
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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. 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
Covered Expenses
Preauthorization
Supplementary Medical Insurance
referral
2. 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.
(PPS) Hospital Impatient Prospective Payment System
(PCN) Primary Care Network
business associate
Privileged information
3. Unauthorized release of information
Subscriber
referring physician
Subscriber
breach of confidential communication
4. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
closed panel HMO
Confidential communication
e-health information management
5. 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
ids
Open Enrollment
privacy
breach of confidential communication
6. What the insurance company will consider paying for as defined in the contract.
(EPO) Exclusive Provider Organization
Consent form
Covered Expenses
disclosure
7. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Treating or performing physician
(PEC) Pre-existing condition
Referral
preauthorization
8. Medicare's method of paying acute care hospitals for inpatient care
Consent form
(PPS) Hospital Impatient Prospective Payment System
(DRG's)
Beneficiary
9. Billing for services not performed
Sub-acute Care
closed panel HMO
phantom billing
Individually identifiable health information
10. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Open Enrollment
pcp
state preemption
Claim
11. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Out of Network (OON)
Specialist
Resonable Charge
(ERISA) Employee Retirement Income Security Act of 1974
12. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
subscriber
(UCR) Usual - Customary and Reasonable
Individually identifiable health information
referral
13. 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
privacy
Maximum Out Of Pocket
14. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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15. 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
(ABN) Advance Beneficiary Notice
Participating Provider
abuse
pos
16. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Treating or performing physician
closed panel HMO
(COB) Coordination of Benefits
disclosure
17. Standards of conduct generally accepted as a moral guide for behavior.
Medigap Insurance
transaction
(PCN) Primary Care Network
ethics
18. A list of the amount to be paid by an insurance company for each procedure service
(APC) Ambulatory Patient Classifications
(DOS) Date of Service
Pre-existing Condition Exclusion
ee schedule
19. A nonprofit integrated delivery system
medical foundation
ids
pcp
phantom billing
20. Individually identifiable health information
subscriber
Amblatory Care
IIHI
(PCN) Primary Care Network
21. A provision that apples when a person is covered under more than one group medical program
ppo
HIPAA
(COB) Coordination of Benefits
(UR) Utilization review
22. 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
(POS) Point-of Service Plan
Protected health information
nonprivileged information
electronic media
23. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
nonprivileged information
state preemption
claim
24. 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.
disclosure
Individually identifiable health information
hmo
Protected health information
25. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
cash flow
Protected health information
(OOPs) Out of Pocket Costs/Expenses
Pre-certification
26. A patient claim is eligible for medicare and medicaid
crossover claim
preauthorization
nonprivileged information
Confidential communication
27. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity
preauthorization
crossover claim
(ABN) Advance Beneficiary Notice
epo
28. A willful act by an employee of taking possession of an employer's money
transaction
Individually identifiable health information
Embezzlement
Open Enrollment
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
(PCN) Primary Care Network
Standard
Amblatory Care
Resonable Charge
30. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
closed panel HMO
electronic media
(AOB) Assignment of Benefits
31. The amount of actual money available to the medical practice
Privileged information
cash flow
privacy
ids
32. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Standard
(DOS) Date of Service
Network
e-health information management
33. An intentional misrepresentation of the facts to deceive or mislead another.
Privacy officer
(EPO) Exclusive Provider Organization
fraud
(Non-par) Non-Participating Provider
34. The dates of healthcare services were provided to the beneficiary
(APC) Ambulatory Patient Classifications
(DOS) Date of Service
cash flow
deductible
35. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
covered entity
confidentiality
referral
(DRG's)
36. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
complience plan
health care provider
Allowed Expenses
Claim
37. 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.
Pre-certification
(PPS) Hospital Impatient Prospective Payment System
Notice of Privacy Practices
deductible
38. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Medigap Insurance
Notice of Privacy Practices
pcp
electronic media
39. A list of the amount to be paid by an insurance company for each procedure service
covered entity
ee schedule
Experimental Procedures
transaction
40. American Medical Association
Covered Expenses
ee schedule
AMA
(UR) Utilization review
41. Individually identifiable health information
IIHI
subscriber
(AOB) Assignment of Benefits
Covered Expenses
42. Customs - rules of conduct - courtesy - and manners of the medical profession
(PPS) Hospital Impatient Prospective Payment System
Experimental Procedures
etiquette
Confidential communication
43. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Allowed Expenses
covered entity
Subscriber
Amblatory Care
44. 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
Covered Expenses
medical foundation
(AOB) Assignment of Benefits
open panel HMO
45. 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
pos
epo
claim
Privileged information
46. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DOS) Date of Service
(DCI) Duplicate Coverage Inquiry
complience plan
IIHI
47. Health Information Portability and Accountability Act
HIPAA
(UR) Utilization review
(PAC) Pre- Admission Certification
Notice of Privacy Practices
48. Medical services provided on an outpatient basis
Amblatory Care
(DOS) Date of Service
health care provider
(POS) Point-of Service Plan
49. A patient claim is eligible for medicare and medicaid
Medigap Insurance
(OOPs) Out of Pocket Costs/Expenses
crossover claim
(DOS) Date of Service
50. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
hmo
preauthorization
disclosure
closed panel HMO