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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. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
deductible
(PEC) Pre-existing condition
Supplementary Medical Insurance
ordering physician
2. 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
health care provider
pos
ethics
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
fraud
(DCI) Duplicate Coverage Inquiry
(PAC) Pre- Admission Certification
Privacy officer
4. 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.
(PPS) Hospital Impatient Prospective Payment System
state preemption
Embezzlement
privacy
5. 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
covered entity
closed panel HMO
open panel HMO
deductible
6. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Individually identifiable health information
Maximum Out Of Pocket
self-referral
Referral
7. Unauthorized release of information
authorization form
confidentiality
referring physician
breach of confidential communication
8. Medical services provided on an outpatient basis
Amblatory Care
Open Enrollment
(ABN) Advance Beneficiary Notice
referral
9. 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
Supplementary Medical Insurance
Open Enrollment
Deductible
(DOS) Date of Service
10. 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
Amblatory Care
covered entity
Confidential communication
Experimental Procedures
11. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
(DME) Durable Medical Equipment
(PPS) Hospital Impatient Prospective Payment System
Beneficiary
12. 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
Embezzlement
ppo
epo
Privileged information
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
preauthorization
Assignment & Authorization
complience plan
Out of Network (OON)
14. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
business associate
hmo
benefit period
15. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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16. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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17. A structure for classifying outpatient services and procedures for purpose of payment
closed panel HMO
Treating or performing physician
(APC) Ambulatory Patient Classifications
crossover claim
18. 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
Privacy officer
Claim
(ABN) Advance Beneficiary Notice
19. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
fraud
health care provider
hmo
Standard
20. 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
electronic media
abuse
(ABN) Advance Beneficiary Notice
(UR) Utilization review
21. A patient claim is eligible for medicare and medicaid
crossover claim
hmo
pcp
Privacy officer
22. 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
referring physician
(Non-par) Non-Participating Provider
Network
23. 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
(UR) Utilization review
IIHI
Covered Expenses
24. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
confidentiality
prepaid plan
(UCR) Usual - Customary and Reasonable
authorization form
25. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
electronic media
consulting physician
confidentiality
referral
26. 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
Amblatory Care
Deductible
Standard
privacy
27. 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.
Confidential communication
pcp
Protected health information
IIHI
28. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Security Rule
Subscriber
benefit period
electronic media
29. A rule - condition - or requirement
Out of Network (OON)
AMA
(PPS) Hospital Impatient Prospective Payment System
Standard
30. A review of the need for inpatient hospital care - completed before the actual admission
Supplementary Medical Insurance
HIPAA
Pre-certification
(PAC) Pre- Admission Certification
31. A provision that apples when a person is covered under more than one group medical program
(PCP) Primary Care Physician
transaction
Confidential communication
(COB) Coordination of Benefits
32. 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
premium
Maximum Out Of Pocket
electronic media
deductible
33. Is the provider who renders a service to a patient
cash flow
Treating or performing physician
Allowed Expenses
Individually identifiable health information
34. 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
(DME) Durable Medical Equipment
(COB) Coordination of Benefits
authorization form
Subscriber
35. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Protected health information
transaction
Network
consulting physician
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
Supplementary Medical Insurance
Amblatory Care
Medigap Insurance
pcp
37. Integrating benefits payable under more than one health insurance.
Out of Network (OON)
Assignment & Authorization
Coordinated Coverage
Open Enrollment
38. 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)
Preauthorization
(PCP) Primary Care Physician
transaction
Consent form
39. 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.
Security Rule
health care provider
Security Rule
Pre-certification
40. The maximum amount a plan pays for a covered service
Referral
Allowed Expenses
Privileged information
fraud
41. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(POS) Point-of Service Plan
complience
cash flow
claim
42. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
(UR) Utilization review
complience plan
(Non-par) Non-Participating Provider
43. 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.
Referral
Pre-certification
Protected health information
(UCR) Usual - Customary and Reasonable
44. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
(Non-par) Non-Participating Provider
(DME) Durable Medical Equipment
subscriber
45. A privileged communication that may be disclosed only with the patient's permission.
(APC) Ambulatory Patient Classifications
Network
Confidential communication
Treating or performing physician
46. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
ppo
referral
Beneficiary
Privileged information
47. 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
Amblatory Care
(APC) Ambulatory Patient Classifications
(TPA) Third Party Administrator
Sub-acute Care
48. 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
fraud
Privileged information
prepaid plan
(Non-par) Non-Participating Provider
49. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Security Rule
e-health information management
(COBRA)
electronic media
50. 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
Security Rule
ordering physician
Maximum Out Of Pocket
state preemption