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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. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
consent
Pre-certification
Experimental Procedures
open panel HMO
2. 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
Experimental Procedures
Security Rule
self-referral
3. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(COB) Coordination of Benefits
attending physician
(TPA) Third Party Administrator
4. A patient claim is eligible for medicare and medicaid
consent
crossover claim
Individually identifiable health information
breach of confidential communication
5. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(PAC) Pre- Admission Certification
Assignment & Authorization
Allowed Expenses
6. The period of time that payment for Medicare inpatient hospital benefits are available
(TPA) Third Party Administrator
benefit period
(DRG's)
pcp
7. Verbal or written agreement that gives approval to some action - situation - or statement.
ethics
consent
prepaid plan
attending physician
8. 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
privacy
Supplementary Medical Insurance
(PAC) Pre- Admission Certification
Pre-certification
9. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
Preauthorization
health care provider
complience plan
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.
Individually identifiable health information
state preemption
covered entity
(OOPs) Out of Pocket Costs/Expenses
11. What the insurance company will consider paying for as defined in the contract.
(UR) Utilization review
premium
Covered Expenses
(EPO) Exclusive Provider Organization
12. 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.
(ERISA) Employee Retirement Income Security Act of 1974
HIPAA
Privileged information
Standard
13. Billing for services not performed
Amblatory Care
transaction
phantom billing
deductible
14. American Medical Association
Network
health care provider
(EPO) Exclusive Provider Organization
AMA
15. 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
(DRG's)
Preauthorization
medical foundation
medical foundation
16. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Covered Expenses
referring physician
IIHI
(OOPs) Out of Pocket Costs/Expenses
17. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(AOB) Assignment of Benefits
abuse
Treating or performing physician
18. 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
Notice of Privacy Practices
etiquette
ids
19. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Amblatory Care
referring physician
Privileged information
20. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
subscriber
consulting physician
Resonable Charge
21. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Maximum Out Of Pocket
Assignment & Authorization
Claim
Individually identifiable health information
22. A patient claim is eligible for medicare and medicaid
crossover claim
Assignment & Authorization
referral
Network
23. 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
subscriber
Treating or performing physician
(PCP) Primary Care Physician
24. An organization of provider sites with a contracted relationship that offer services
ids
Network
electronic media
Pre-certification
25. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PAC) Pre- Admission Certification
(PEC) Pre-existing condition
complience
privacy
26. Individually identifiable health information
medical foundation
ordering physician
IIHI
privacy
27. A willful act by an employee of taking possession of an employer's money
ppo
Embezzlement
open panel HMO
Subscriber
28. 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
ids
AMA
Allowed Expenses
open panel HMO
29. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(UCR) Usual - Customary and Reasonable
claim
Protected health information
closed panel HMO
30. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Supplementary Medical Insurance
(PCN) Primary Care Network
epo
31. A review of the need for inpatient hospital care - completed before the actual admission
Pre-existing Condition Exclusion
(DCI) Duplicate Coverage Inquiry
Individually identifiable health information
(PAC) Pre- Admission Certification
32. A structure for classifying outpatient services and procedures for purpose of payment
abuse
(APC) Ambulatory Patient Classifications
Subscriber
Security Rule
33. A structure for classifying outpatient services and procedures for purpose of payment
Preauthorization
(TPA) Third Party Administrator
pos
(APC) Ambulatory Patient Classifications
34. 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.
Allowed Expenses
security officer
Assignment & Authorization
Claim
35. 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
complience
complience
benefit period
nonprivileged information
36. American Medical Association
crossover claim
AMA
ethics
Claim
37. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(EPO) Exclusive Provider Organization
pcp
privacy
Pre-existing Condition Exclusion
38. The amount of actual money available to the medical practice
cash flow
AMA
(AOB) Assignment of Benefits
Preauthorization
39. 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
Embezzlement
e-health information management
Participating Provider
(UCR) Usual - Customary and Reasonable
40. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
econdary Payer
preauthorization
open panel HMO
claim
41. 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.
Coordinated Coverage
(POS) Point-of Service Plan
ordering physician
Notice of Privacy Practices
42. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
attending physician
pcp
claim
hmo
43. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Out of Network (OON)
subscriber
business associate
nonprivileged information
44. 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
crossover claim
(EPO) Exclusive Provider Organization
pos
45. 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)
subscriber
Consent form
nonprivileged information
prepaid plan
46. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
benefit period
Security Rule
pos
47. 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
cash flow
AMA
Maximum Out Of Pocket
electronic media
48. Verbal or written agreement that gives approval to some action - situation - or statement.
closed panel HMO
AMA
consent
subscriber
49. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(UR) Utilization review
Resonable Charge
Out of Network (OON)
HIPAA
50. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
(APC) Ambulatory Patient Classifications
e-health information management
(TPA) Third Party Administrator