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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. 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
AMA
Subscriber
(ABN) Advance Beneficiary Notice
epo
2. Medicare's method of paying acute care hospitals for inpatient care
referring physician
electronic media
(PPS) Hospital Impatient Prospective Payment System
referral
3. The condition of being secluded from the presence or view of others.
HIPAA
(POS) Point-of Service Plan
self-referral
privacy
4. 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.
pcp
e-health information management
Privileged information
nonprivileged information
5. American Medical Association
Resonable Charge
cash flow
AMA
(UR) Utilization review
6. A provision that apples when a person is covered under more than one group medical program
cash flow
health care provider
(COB) Coordination of Benefits
Assignment & Authorization
7. 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
(PCP) Primary Care Physician
Network
deductible
deductible
8. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(PAC) Pre- Admission Certification
premium
(UCR) Usual - Customary and Reasonable
crossover claim
9. 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
HIPAA
Sub-acute Care
prepaid plan
10. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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11. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Pre-certification
phantom billing
clearinghouse
(APC) Ambulatory Patient Classifications
12. 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
pos
Treating or performing physician
pcp
ee schedule
13. Medicare's method of paying acute care hospitals for inpatient care
IIHI
open panel HMO
(PPS) Hospital Impatient Prospective Payment System
(DME) Durable Medical Equipment
14. 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
Supplementary Medical Insurance
Open Enrollment
(DOS) Date of Service
preauthorization
15. 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.
Open Enrollment
Privileged information
ids
authorization form
16. A provider of medical or health services and any other person or organization who furnishes bills or is paid for health care in the normal course of business.
health care provider
HIPAA
(POS) Point-of Service Plan
(PPS) Hospital Impatient Prospective Payment System
17. The period of time that payment for Medicare inpatient hospital benefits are available
Notice of Privacy Practices
covered entity
benefit period
Privacy officer
18. 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
ee schedule
Security Rule
Participating Provider
hmo
19. Billing for services not performed
fraud
authorization form
(POS) Point-of Service Plan
phantom billing
20. 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
Out of Network (OON)
Covered Expenses
econdary Payer
Deductible
21. A willful act by an employee of taking possession of an employer's money
econdary Payer
Embezzlement
abuse
Specialist
22. 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.
Assignment & Authorization
Notice of Privacy Practices
(APC) Ambulatory Patient Classifications
Participating Provider
23. 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
ee schedule
crossover claim
Pre-existing Condition Exclusion
24. 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
Pre-certification
crossover claim
Maximum Out Of Pocket
Deductible
25. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
crossover claim
confidentiality
abuse
(DRG's)
26. 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
(ABN) Advance Beneficiary Notice
state preemption
closed panel HMO
ppo
27. The maximum amount a plan pays for a covered service
Covered Expenses
(Non-par) Non-Participating Provider
(PCN) Primary Care Network
Allowed Expenses
28. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Embezzlement
Coordinated Coverage
Assignment & Authorization
ordering physician
29. 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.
Pre-certification
(TPA) Third Party Administrator
state preemption
claim
30. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Resonable Charge
Privacy officer
Network
Confidential communication
31. 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.
(ERISA) Employee Retirement Income Security Act of 1974
Notice of Privacy Practices
(DOS) Date of Service
Pre-certification
32. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Participating Provider
Referral
ee schedule
Privileged information
33. Is a provider who sends the patients for testing or treatment
ppo
referring physician
Confidential communication
(UR) Utilization review
34. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(DOS) Date of Service
(OOPs) Out of Pocket Costs/Expenses
ee schedule
privacy
35. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
complience plan
Referral
AMA
Consent form
36. Standards of conduct generally accepted as a moral guide for behavior.
Treating or performing physician
AMA
medical foundation
ethics
37. A clinic that is owned by the HMO and the physicians are employees of the HMO
(EPO) Exclusive Provider Organization
Experimental Procedures
closed panel HMO
(ABN) Advance Beneficiary Notice
38. An intentional misrepresentation of the facts to deceive or mislead another.
Referral
Allowed Expenses
fraud
Allowed Expenses
39. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Embezzlement
(Non-par) Non-Participating Provider
(PPS) Hospital Impatient Prospective Payment System
Pre-certification
40. 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
Coordinated Coverage
AMA
prepaid plan
(PCP) Primary Care Physician
41. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(PCP) Primary Care Physician
preauthorization
breach of confidential communication
(EPO) Exclusive Provider Organization
42. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
econdary Payer
Privacy officer
benefit period
disclosure
43. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Privileged information
(OOPs) Out of Pocket Costs/Expenses
Allowed Expenses
(EPO) Exclusive Provider Organization
44. A monthly fee paid by the insured for specific medical insurance coverage
e-health information management
premium
electronic media
self-referral
45. 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
confidentiality
abuse
AMA
econdary Payer
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
(EPO) Exclusive Provider Organization
Allowed Expenses
Amblatory Care
(DCI) Duplicate Coverage Inquiry
47. Someone who is eligible for or receiving benefits under an insurance policy or plan
benefit period
complience plan
Notice of Privacy Practices
Beneficiary
48. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations
consent
authorization form
AMA
referral
49. American Medical Association
Standard
AMA
Individually identifiable health information
breach of confidential communication
50. A monthly fee paid by the insured for specific medical insurance coverage
covered entity
attending physician
premium
(ERISA) Employee Retirement Income Security Act of 1974