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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. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
benefit period
Resonable Charge
pcp
authorization form
2. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
Supplementary Medical Insurance
Maximum Out Of Pocket
state preemption
3. 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
subscriber
(PCN) Primary Care Network
Standard
4. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Privileged information
disclosure
Coordinated Coverage
Allowed Expenses
5. 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
(PEC) Pre-existing condition
Coordinated Coverage
Security Rule
transaction
6. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(EPO) Exclusive Provider Organization
Consent form
Maximum Out Of Pocket
7. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
hmo
referral
(PEC) Pre-existing condition
open panel HMO
8. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
phantom billing
health care provider
consulting physician
Individually identifiable health information
9. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
closed panel HMO
Maximum Out Of Pocket
Specialist
(COB) Coordination of Benefits
10. 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
Network
Experimental Procedures
health care provider
Security Rule
11. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
(COBRA)
Pre-existing Condition Exclusion
Amblatory Care
Deductible
12. Is the provider who renders a service to a patient
(AOB) Assignment of Benefits
premium
Treating or performing physician
(APC) Ambulatory Patient Classifications
13. What the insurance company will consider paying for as defined in the contract.
e-health information management
Notice of Privacy Practices
Covered Expenses
(COB) Coordination of Benefits
14. Is a provider who sends the patients for testing or treatment
referral
pcp
medical foundation
referring physician
15. 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
Pre-existing Condition Exclusion
ids
Covered Expenses
(APC) Ambulatory Patient Classifications
16. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(ABN) Advance Beneficiary Notice
(POS) Point-of Service Plan
Subscriber
ppo
17. A monthly fee paid by the insured for specific medical insurance coverage
confidentiality
complience
(DRG's)
premium
18. The amount of actual money available to the medical practice
econdary Payer
medical foundation
cash flow
fraud
19. 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
Pre-existing Condition Exclusion
referring physician
prepaid plan
Claim
20. American Medical Association
premium
AMA
(COBRA)
medical foundation
21. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
breach of confidential communication
premium
Standard
22. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
referral
ppo
(POS) Point-of Service Plan
23. 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
subscriber
Privileged information
Preauthorization
(POS) Point-of Service Plan
24. 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
transaction
Resonable Charge
(AOB) Assignment of Benefits
phantom billing
25. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Treating or performing physician
breach of confidential communication
Deductible
state preemption
26. 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.
Medigap Insurance
Assignment & Authorization
HIPAA
business associate
27. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DME) Durable Medical Equipment
(DCI) Duplicate Coverage Inquiry
complience plan
prepaid plan
28. Unauthorized release of information
Participating Provider
breach of confidential communication
Resonable Charge
covered entity
29. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
phantom billing
attending physician
complience
30. A monthly fee paid by the insured for specific medical insurance coverage
premium
security officer
Network
epo
31. A rule - condition - or requirement
Standard
complience plan
claim
Notice of Privacy Practices
32. 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
Amblatory Care
(AOB) Assignment of Benefits
(DME) Durable Medical Equipment
econdary Payer
33. 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
Deductible
epo
Network
(DME) Durable Medical Equipment
34. The period of time that payment for Medicare inpatient hospital benefits are available
transaction
benefit period
Participating Provider
Embezzlement
35. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
health care provider
Confidential communication
deductible
Supplementary Medical Insurance
36. 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.
Confidential communication
business associate
Beneficiary
Covered Expenses
37. 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.
Consent form
consulting physician
Privacy officer
state preemption
38. 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
ee schedule
(TPA) Third Party Administrator
Network
39. 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
IIHI
(PCN) Primary Care Network
authorization form
Security Rule
40. A list of the amount to be paid by an insurance company for each procedure service
consent
pcp
health care provider
ee schedule
41. 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
Individually identifiable health information
econdary Payer
nonprivileged information
phantom billing
42. What the insurance company will consider paying for as defined in the contract.
benefit period
electronic media
deductible
Covered Expenses
43. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(Non-par) Non-Participating Provider
Supplementary Medical Insurance
closed panel HMO
Medigap Insurance
44. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
self-referral
disclosure
disclosure
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
claim
Medigap Insurance
epo
abuse
46. 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
referring physician
Allowed Expenses
ids
open panel HMO
47. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
ppo
Referral
(DCI) Duplicate Coverage Inquiry
Network
48. 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
subscriber
Individually identifiable health information
Preauthorization
self-referral
49. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Beneficiary
Confidential communication
pcp
pos
50. 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
(COB) Coordination of Benefits
nonprivileged information
fraud
Resonable Charge