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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. 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
(UCR) Usual - Customary and Reasonable
nonprivileged information
claim
(PCN) Primary Care Network
2. A health insurance enrollee chooses to see an out of network provider without authorization
(AOB) Assignment of Benefits
self-referral
(DOS) Date of Service
(PCP) Primary Care Physician
3. Verbal or written agreement that gives approval to some action - situation - or statement.
(COB) Coordination of Benefits
consent
authorization form
Deductible
4. Medical services provided on an outpatient basis
Supplementary Medical Insurance
Amblatory Care
ids
consulting physician
5. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
consulting physician
Network
phantom billing
6. Verbal or written agreement that gives approval to some action - situation - or statement.
Resonable Charge
clearinghouse
consent
confidentiality
7. Is a provider who sends the patients for testing or treatment
referring physician
referral
Preauthorization
claim
8. 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
pcp
crossover claim
Experimental Procedures
Security Rule
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
AMA
Protected health information
premium
10. Customs - rules of conduct - courtesy - and manners of the medical profession
(OOPs) Out of Pocket Costs/Expenses
deductible
etiquette
covered entity
11. 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
confidentiality
Pre-existing Condition Exclusion
(Non-par) Non-Participating Provider
cash flow
12. 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
(UCR) Usual - Customary and Reasonable
(PCP) Primary Care Physician
complience plan
(PCN) Primary Care Network
13. 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
Assignment & Authorization
Embezzlement
health care provider
Treating or performing physician
14. A review of the need for inpatient hospital care - completed before the actual admission
benefit period
referring physician
(PAC) Pre- Admission Certification
Deductible
15. 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.
attending physician
(PEC) Pre-existing condition
business associate
consent
16. Medical services provided on an outpatient basis
Assignment & Authorization
fraud
Amblatory Care
nonprivileged information
17. The amount of actual money available to the medical practice
cash flow
prepaid plan
nonprivileged information
(DCI) Duplicate Coverage Inquiry
18. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
deductible
(PEC) Pre-existing condition
Supplementary Medical Insurance
Notice of Privacy Practices
19. Integrating benefits payable under more than one health insurance.
Privacy officer
confidentiality
consulting physician
Coordinated Coverage
20. A willful act by an employee of taking possession of an employer's money
fraud
Consent form
Embezzlement
phantom billing
21. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
ppo
Pre-certification
(EPO) Exclusive Provider Organization
22. 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
referral
Deductible
(DCI) Duplicate Coverage Inquiry
pos
23. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(APC) Ambulatory Patient Classifications
clearinghouse
ee schedule
24. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Security Rule
HIPAA
consent
deductible
25. 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.
etiquette
security officer
referring physician
clearinghouse
26. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
clearinghouse
Protected health information
Pre-certification
hmo
27. A willful act by an employee of taking possession of an employer's money
referring physician
Pre-certification
Embezzlement
Individually identifiable health information
28. 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
clearinghouse
(DOS) Date of Service
(PCP) Primary Care Physician
(APC) Ambulatory Patient Classifications
29. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Claim
(UCR) Usual - Customary and Reasonable
pos
consulting physician
30. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Privacy officer
confidentiality
(DCI) Duplicate Coverage Inquiry
ids
31. A nonprofit integrated delivery system
medical foundation
Standard
(PCP) Primary Care Physician
Assignment & Authorization
32. Unauthorized release of information
IIHI
breach of confidential communication
(UR) Utilization review
phantom billing
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.
self-referral
complience
closed panel HMO
Protected health information
34. The maximum amount a plan pays for a covered service
medical foundation
Treating or performing physician
Consent form
Allowed Expenses
35. An intentional misrepresentation of the facts to deceive or mislead another.
(PAC) Pre- Admission Certification
premium
fraud
(DOS) Date of Service
36. 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
AMA
Covered Expenses
open panel HMO
IIHI
37. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
closed panel HMO
(AOB) Assignment of Benefits
business associate
38. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(AOB) Assignment of Benefits
complience plan
(DME) Durable Medical Equipment
39. Someone who is eligible for or receiving benefits under an insurance policy or plan
Experimental Procedures
security officer
(ABN) Advance Beneficiary Notice
Beneficiary
40. The period of time that payment for Medicare inpatient hospital benefits are available
consulting physician
ordering physician
ordering physician
benefit period
41. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Experimental Procedures
Individually identifiable health information
attending physician
Confidential communication
42. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(APC) Ambulatory Patient Classifications
(TPA) Third Party Administrator
pcp
authorization form
43. 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
Maximum Out Of Pocket
Covered Expenses
Standard
ppo
44. 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.
(ABN) Advance Beneficiary Notice
Covered Expenses
(DCI) Duplicate Coverage Inquiry
Privileged information
45. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Standard
Out of Network (OON)
(PEC) Pre-existing condition
46. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PPS) Hospital Impatient Prospective Payment System
AMA
confidentiality
transaction
47. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
self-referral
benefit period
(OOPs) Out of Pocket Costs/Expenses
consulting physician
48. 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
clearinghouse
(COB) Coordination of Benefits
HIPAA
49. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
phantom billing
ids
(OOPs) Out of Pocket Costs/Expenses
closed panel HMO
50. An intentional misrepresentation of the facts to deceive or mislead another.
(OOPs) Out of Pocket Costs/Expenses
fraud
ordering physician
Participating Provider