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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. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(DRG's)
Referral
Standard
2. Individually identifiable health information
Security Rule
IIHI
ethics
etiquette
3. 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
Deductible
authorization form
prepaid plan
4. 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.
e-health information management
business associate
confidentiality
(AOB) Assignment of Benefits
5. 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
Assignment & Authorization
(DME) Durable Medical Equipment
Resonable Charge
6. The dates of healthcare services were provided to the beneficiary
Pre-certification
Referral
(DOS) Date of Service
Covered Expenses
7. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
attending physician
self-referral
Pre-certification
Individually identifiable health information
8. A monthly fee paid by the insured for specific medical insurance coverage
premium
Experimental Procedures
clearinghouse
Participating Provider
9. Customs - rules of conduct - courtesy - and manners of the medical profession
Open Enrollment
etiquette
breach of confidential communication
cash flow
10. A clinic that is owned by the HMO and the physicians are employees of the HMO
crossover claim
electronic media
closed panel HMO
(DRG's)
11. 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
nonprivileged information
(PPS) Hospital Impatient Prospective Payment System
(EPO) Exclusive Provider Organization
(PCN) Primary Care Network
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
(PAC) Pre- Admission Certification
referral
Embezzlement
13. 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
disclosure
deductible
Individually identifiable health information
(AOB) Assignment of Benefits
14. Is a provider who sends the patients for testing or treatment
fraud
(DME) Durable Medical Equipment
referring physician
state preemption
15. 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.
Privacy officer
deductible
ee schedule
Privileged information
16. 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
(PCP) Primary Care Physician
ordering physician
Pre-existing Condition Exclusion
complience plan
17. A list of the amount to be paid by an insurance company for each procedure service
Beneficiary
ee schedule
(PEC) Pre-existing condition
Consent form
18. Medical staff member who is legally responsible for the care and treatment given to a patient.
Maximum Out Of Pocket
Preauthorization
deductible
attending physician
19. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
nonprivileged information
AMA
Notice of Privacy Practices
20. 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
consent
open panel HMO
Treating or performing physician
state preemption
21. A patient claim is eligible for medicare and medicaid
Claim
business associate
transaction
crossover claim
22. A review of the need for inpatient hospital care - completed before the actual admission
Maximum Out Of Pocket
(PAC) Pre- Admission Certification
self-referral
(POS) Point-of Service Plan
23. 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
(TPA) Third Party Administrator
Network
authorization form
Medigap Insurance
24. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
authorization form
deductible
closed panel HMO
25. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
(APC) Ambulatory Patient Classifications
Maximum Out Of Pocket
(TPA) Third Party Administrator
(COBRA)
26. Customs - rules of conduct - courtesy - and manners of the medical profession
Privileged information
complience plan
Supplementary Medical Insurance
etiquette
27. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
prepaid plan
(DCI) Duplicate Coverage Inquiry
deductible
Resonable Charge
28. 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
Experimental Procedures
Claim
(Non-par) Non-Participating Provider
29. An intentional misrepresentation of the facts to deceive or mislead another.
Supplementary Medical Insurance
fraud
(UCR) Usual - Customary and Reasonable
Protected health information
30. The maximum amount a plan pays for a covered service
Allowed Expenses
(POS) Point-of Service Plan
ethics
Embezzlement
31. 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
(COB) Coordination of Benefits
ppo
(POS) Point-of Service Plan
Specialist
32. 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
Sub-acute Care
abuse
ids
pcp
33. Medical services provided on an outpatient basis
Network
state preemption
Maximum Out Of Pocket
Amblatory Care
34. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
(OOPs) Out of Pocket Costs/Expenses
(DOS) Date of Service
clearinghouse
35. 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
Maximum Out Of Pocket
subscriber
(OOPs) Out of Pocket Costs/Expenses
referral
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
benefit period
Subscriber
consulting physician
Supplementary Medical Insurance
37. 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
hmo
consent
health care provider
38. 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
hmo
(UR) Utilization review
Participating Provider
(TPA) Third Party Administrator
39. 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
complience plan
Experimental Procedures
(ABN) Advance Beneficiary Notice
closed panel HMO
40. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
HIPAA
(TPA) Third Party Administrator
self-referral
Network
41. A list of the amount to be paid by an insurance company for each procedure service
etiquette
ee schedule
transaction
(DOS) Date of Service
42. The period of time that payment for Medicare inpatient hospital benefits are available
Allowed Expenses
benefit period
Protected health information
business associate
43. Billing for services not performed
phantom billing
confidentiality
covered entity
(DCI) Duplicate Coverage Inquiry
44. 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
disclosure
preauthorization
referring physician
45. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
ordering physician
confidentiality
Privileged information
46. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
Beneficiary
privacy
referring physician
47. A patient claim is eligible for medicare and medicaid
crossover claim
preauthorization
confidentiality
closed panel HMO
48. A clinic that is owned by the HMO and the physicians are employees of the HMO
complience plan
Out of Network (OON)
hmo
closed panel HMO
49. 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.
(COBRA)
(UCR) Usual - Customary and Reasonable
clearinghouse
security officer
50. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
abuse
Amblatory Care
Resonable Charge
Confidential communication