SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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 member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Out of Network (OON)
(APC) Ambulatory Patient Classifications
subscriber
pos
2. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
cash flow
(OOPs) Out of Pocket Costs/Expenses
(EPO) Exclusive Provider Organization
Embezzlement
3. Unauthorized release of information
breach of confidential communication
econdary Payer
self-referral
clearinghouse
4. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
epo
health care provider
Resonable Charge
(PCN) Primary Care Network
5. 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.
(PCN) Primary Care Network
security officer
(DME) Durable Medical Equipment
health care provider
6. 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
(PEC) Pre-existing condition
Privileged information
(POS) Point-of Service Plan
complience
7. 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
privacy
(ABN) Advance Beneficiary Notice
HIPAA
Pre-certification
8. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
prepaid plan
medical foundation
ordering physician
9. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
Warning
: Invalid argument supplied for foreach() in
/var/www/html/basicversity.com/show_quiz.php
on line
183
10. A willful act by an employee of taking possession of an employer's money
(ERISA) Employee Retirement Income Security Act of 1974
Deductible
Embezzlement
consent
11. 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
ppo
IIHI
Resonable Charge
(TPA) Third Party Administrator
12. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Consent form
fraud
Assignment & Authorization
ordering physician
13. 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
Open Enrollment
covered entity
phantom billing
Individually identifiable health information
14. 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
referring physician
Individually identifiable health information
ppo
consulting physician
15. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Subscriber
clearinghouse
AMA
business associate
16. A monthly fee paid by the insured for specific medical insurance coverage
Medigap Insurance
(UR) Utilization review
premium
Out of Network (OON)
17. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(PAC) Pre- Admission Certification
referral
Privileged information
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.
(PCP) Primary Care Physician
referring physician
Privacy officer
transaction
19. The dates of healthcare services were provided to the beneficiary
Coordinated Coverage
Experimental Procedures
pos
(DOS) Date of Service
20. A monthly fee paid by the insured for specific medical insurance coverage
premium
Preauthorization
hmo
(PCN) Primary Care Network
21. A health insurance enrollee chooses to see an out of network provider without authorization
etiquette
self-referral
Open Enrollment
(COB) Coordination of Benefits
22. Customs - rules of conduct - courtesy - and manners of the medical profession
Confidential communication
referral
security officer
etiquette
23. A willful act by an employee of taking possession of an employer's money
Embezzlement
(PPS) Hospital Impatient Prospective Payment System
(ERISA) Employee Retirement Income Security Act of 1974
Standard
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
Individually identifiable health information
Consent form
Pre-existing Condition Exclusion
Maximum Out Of Pocket
25. An organization of provider sites with a contracted relationship that offer services
ids
Referral
pcp
prepaid plan
26. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
authorization form
(PEC) Pre-existing condition
preauthorization
fraud
27. A provision that apples when a person is covered under more than one group medical program
Amblatory Care
(COB) Coordination of Benefits
(ERISA) Employee Retirement Income Security Act of 1974
Claim
28. An intentional misrepresentation of the facts to deceive or mislead another.
Privacy officer
fraud
referral
(DME) Durable Medical Equipment
29. 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
prepaid plan
ordering physician
covered entity
30. 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
(UR) Utilization review
HIPAA
AMA
epo
31. A review of the need for inpatient hospital care - completed before the actual admission
(PPS) Hospital Impatient Prospective Payment System
business associate
(PAC) Pre- Admission Certification
referring physician
32. 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
complience plan
(OOPs) Out of Pocket Costs/Expenses
attending physician
Deductible
33. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
attending physician
(OOPs) Out of Pocket Costs/Expenses
Beneficiary
34. The maximum amount a plan pays for a covered service
Allowed Expenses
(EPO) Exclusive Provider Organization
preauthorization
state preemption
35. Is the provider who renders a service to a patient
Treating or performing physician
Privacy officer
(POS) Point-of Service Plan
Network
36. 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
e-health information management
benefit period
(Non-par) Non-Participating Provider
ppo
37. A review of the need for inpatient hospital care - completed before the actual admission
(UR) Utilization review
Individually identifiable health information
breach of confidential communication
(PAC) Pre- Admission Certification
38. 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
epo
(PEC) Pre-existing condition
(DCI) Duplicate Coverage Inquiry
state preemption
39. 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
self-referral
prepaid plan
Maximum Out Of Pocket
deductible
40. 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)
hmo
Consent form
Subscriber
Standard
41. The amount of actual money available to the medical practice
IIHI
cash flow
privacy
Notice of Privacy Practices
42. The maximum amount a plan pays for a covered service
fraud
(AOB) Assignment of Benefits
Allowed Expenses
AMA
43. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
disclosure
Resonable Charge
subscriber
44. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
attending physician
(PCP) Primary Care Physician
self-referral
45. 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
Assignment & Authorization
clearinghouse
e-health information management
(PCP) Primary Care Physician
46. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
pcp
Deductible
claim
consent
47. A structure for classifying outpatient services and procedures for purpose of payment
(DRG's)
e-health information management
(APC) Ambulatory Patient Classifications
cash flow
48. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
(Non-par) Non-Participating Provider
abuse
(OOPs) Out of Pocket Costs/Expenses
49. An intentional misrepresentation of the facts to deceive or mislead another.
Covered Expenses
(POS) Point-of Service Plan
fraud
(PCP) Primary Care Physician
50. A rule - condition - or requirement
Confidential communication
(APC) Ambulatory Patient Classifications
(DRG's)
Standard