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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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.
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 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
consent
Maximum Out Of Pocket
complience plan
health care provider
2. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(DCI) Duplicate Coverage Inquiry
(PCP) Primary Care Physician
e-health information management
Pre-certification
3. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Sub-acute Care
Pre-certification
phantom billing
deductible
4. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Coordinated Coverage
Resonable Charge
Network
consulting physician
5. 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.
Notice of Privacy Practices
(TPA) Third Party Administrator
Privileged information
consent
6. Individually identifiable health information
IIHI
electronic media
nonprivileged information
disclosure
7. 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
Claim
Notice of Privacy Practices
prepaid plan
8. Unauthorized release of information
epo
medical foundation
breach of confidential communication
(PCP) Primary Care Physician
9. The condition of being secluded from the presence or view of others.
Resonable Charge
Resonable Charge
prepaid plan
privacy
10. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Assignment & Authorization
referral
transaction
disclosure
11. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
medical foundation
Specialist
Embezzlement
Coordinated Coverage
12. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
13. 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
IIHI
Supplementary Medical Insurance
(COB) Coordination of Benefits
health care provider
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Maximum Out Of Pocket
consulting physician
Treating or performing physician
e-health information management
15. An organization of provider sites with a contracted relationship that offer services
consulting physician
confidentiality
ids
Supplementary Medical Insurance
16. The amount of actual money available to the medical practice
Preauthorization
Consent form
crossover claim
cash flow
17. Billing for services not performed
AMA
(PCN) Primary Care Network
covered entity
phantom billing
18. An organization of provider sites with a contracted relationship that offer services
(DOS) Date of Service
Pre-certification
(POS) Point-of Service Plan
ids
19. A nonprofit integrated delivery system
Resonable Charge
benefit period
crossover claim
medical foundation
20. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
consulting physician
electronic media
AMA
21. The maximum amount a plan pays for a covered service
Medigap Insurance
pos
attending physician
Allowed Expenses
22. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Privileged information
Open Enrollment
Specialist
(OOPs) Out of Pocket Costs/Expenses
23. 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
(UR) Utilization review
(AOB) Assignment of Benefits
etiquette
Embezzlement
24. 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
(DOS) Date of Service
(ERISA) Employee Retirement Income Security Act of 1974
(DRG's)
Experimental Procedures
25. 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
preauthorization
(POS) Point-of Service Plan
(DCI) Duplicate Coverage Inquiry
Assignment & Authorization
26. 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
privacy
(AOB) Assignment of Benefits
cash flow
Assignment & Authorization
27. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
AMA
confidentiality
Protected health information
abuse
28. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Notice of Privacy Practices
pcp
ethics
Participating Provider
29. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Pre-certification
disclosure
subscriber
Claim
30. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Covered Expenses
abuse
security officer
(TPA) Third Party Administrator
31. Medical staff member who is legally responsible for the care and treatment given to a patient.
Privileged information
(DRG's)
preauthorization
attending physician
32. 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
Open Enrollment
etiquette
subscriber
crossover claim
33. 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.
Protected health information
(PEC) Pre-existing condition
prepaid plan
Referral
34. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
(POS) Point-of Service Plan
preauthorization
disclosure
35. Unauthorized release of information
breach of confidential communication
preauthorization
etiquette
complience
36. 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
security officer
(PCN) Primary Care Network
Deductible
Supplementary Medical Insurance
37. 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
Participating Provider
e-health information management
Out of Network (OON)
38. A list of the amount to be paid by an insurance company for each procedure service
ordering physician
Coordinated Coverage
ee schedule
Treating or performing physician
39. 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
phantom billing
(DRG's)
health care provider
40. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
Deductible
prepaid plan
epo
41. 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
confidentiality
referral
(DOS) Date of Service
42. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Treating or performing physician
abuse
Sub-acute Care
Resonable Charge
43. 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
closed panel HMO
hmo
Covered Expenses
44. 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.
complience plan
Claim
subscriber
business associate
45. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
transaction
Preauthorization
(UCR) Usual - Customary and Reasonable
IIHI
46. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
disclosure
econdary Payer
Referral
47. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(PCP) Primary Care Physician
(DCI) Duplicate Coverage Inquiry
(UCR) Usual - Customary and Reasonable
(EPO) Exclusive Provider Organization
48. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Beneficiary
Assignment & Authorization
Confidential communication
49. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PCP) Primary Care Physician
complience
Deductible
Resonable Charge
50. 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
epo
Protected health information
hmo
IIHI