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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. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Standard
business associate
(PAC) Pre- Admission Certification
2. 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
ordering physician
Confidential communication
nonprivileged information
(ABN) Advance Beneficiary Notice
3. 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
Embezzlement
Pre-existing Condition Exclusion
Beneficiary
(DRG's)
4. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
IIHI
Sub-acute Care
(DME) Durable Medical Equipment
econdary Payer
5. The period of time that payment for Medicare inpatient hospital benefits are available
Sub-acute Care
IIHI
state preemption
benefit period
6. 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
etiquette
e-health information management
(Non-par) Non-Participating Provider
prepaid plan
7. A patient claim is eligible for medicare and medicaid
Pre-existing Condition Exclusion
closed panel HMO
Assignment & Authorization
crossover claim
8. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
attending physician
Deductible
covered entity
Privileged information
9. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
crossover claim
(UCR) Usual - Customary and Reasonable
nonprivileged information
10. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
epo
AMA
Individually identifiable health information
(COBRA)
11. Someone who is eligible for or receiving benefits under an insurance policy or plan
Open Enrollment
Sub-acute Care
ppo
Beneficiary
12. Billing for services not performed
breach of confidential communication
fraud
Network
phantom billing
13. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Medigap Insurance
hmo
subscriber
confidentiality
14. Standards of conduct generally accepted as a moral guide for behavior.
Coordinated Coverage
Experimental Procedures
ethics
(PCP) Primary Care Physician
15. 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
(COB) Coordination of Benefits
ppo
privacy
premium
16. Medical services provided on an outpatient basis
security officer
Privileged information
Amblatory Care
Protected health information
17. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
ordering physician
consulting physician
Amblatory Care
ids
18. A rule - condition - or requirement
Assignment & Authorization
Pre-certification
Standard
(DOS) Date of Service
19. 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
(ERISA) Employee Retirement Income Security Act of 1974
AMA
(PCP) Primary Care Physician
Specialist
20. 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
closed panel HMO
Sub-acute Care
state preemption
21. Is the provider who renders a service to a patient
Beneficiary
Experimental Procedures
Treating or performing physician
Network
22. American Medical Association
(Non-par) Non-Participating Provider
(PPS) Hospital Impatient Prospective Payment System
premium
AMA
23. Is a provider who sends the patients for testing or treatment
Maximum Out Of Pocket
deductible
referring physician
(PEC) Pre-existing condition
24. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
self-referral
IIHI
confidentiality
Protected health information
25. Medicare's method of paying acute care hospitals for inpatient care
pcp
(PPS) Hospital Impatient Prospective Payment System
complience
premium
26. The condition of being secluded from the presence or view of others.
Open Enrollment
deductible
privacy
clearinghouse
27. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
closed panel HMO
HIPAA
subscriber
premium
28. 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
hmo
Sub-acute Care
Assignment & Authorization
state preemption
29. The amount of actual money available to the medical practice
Claim
confidentiality
cash flow
health care provider
30. A review of the need for inpatient hospital care - completed before the actual admission
electronic media
pos
Individually identifiable health information
(PAC) Pre- Admission Certification
31. 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
hmo
confidentiality
Privacy officer
Maximum Out Of Pocket
32. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
claim
Network
(DRG's)
33. 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
phantom billing
(AOB) Assignment of Benefits
econdary Payer
Subscriber
34. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(DCI) Duplicate Coverage Inquiry
Beneficiary
complience plan
e-health information management
35. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(PAC) Pre- Admission Certification
benefit period
Out of Network (OON)
Resonable Charge
36. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
ee schedule
self-referral
consent
complience
37. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
phantom billing
Consent form
Resonable Charge
38. What the insurance company will consider paying for as defined in the contract.
(AOB) Assignment of Benefits
claim
Covered Expenses
(COB) Coordination of Benefits
39. 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
Experimental Procedures
preauthorization
Open Enrollment
nonprivileged information
40. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Consent form
(APC) Ambulatory Patient Classifications
(EPO) Exclusive Provider Organization
(COBRA)
41. 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.
Assignment & Authorization
security officer
(TPA) Third Party Administrator
Security Rule
42. 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
Deductible
subscriber
attending physician
ee schedule
43. The dates of healthcare services were provided to the beneficiary
(UR) Utilization review
(ABN) Advance Beneficiary Notice
(DOS) Date of Service
Treating or performing physician
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
open panel HMO
(PEC) Pre-existing condition
HIPAA
(TPA) Third Party Administrator
45. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(POS) Point-of Service Plan
consent
e-health information management
(UCR) Usual - Customary and Reasonable
46. A review of the need for inpatient hospital care - completed before the actual admission
(POS) Point-of Service Plan
Preauthorization
(PAC) Pre- Admission Certification
privacy
47. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(TPA) Third Party Administrator
Standard
Subscriber
(DME) Durable Medical Equipment
48. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Treating or performing physician
(UCR) Usual - Customary and Reasonable
Pre-certification
Out of Network (OON)
49. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Consent form
e-health information management
authorization form
Individually identifiable health information
50. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Covered Expenses
transaction
(PCP) Primary Care Physician
covered entity