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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. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
preauthorization
IIHI
health care provider
(PEC) Pre-existing condition
2. 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
Sub-acute Care
epo
privacy
Allowed Expenses
3. Medical staff member who is legally responsible for the care and treatment given to a patient.
Pre-certification
hmo
covered entity
attending physician
4. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Network
electronic media
(PAC) Pre- Admission Certification
5. Health Information Portability and Accountability Act
state preemption
ethics
subscriber
HIPAA
6. 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)
Consent form
consent
Preauthorization
Notice of Privacy Practices
7. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
Maximum Out Of Pocket
(COBRA)
Referral
8. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
(AOB) Assignment of Benefits
Resonable Charge
claim
9. Health Information Portability and Accountability Act
electronic media
HIPAA
Individually identifiable health information
(POS) Point-of Service 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.
Covered Expenses
ethics
consent
Individually identifiable health information
11. Unauthorized release of information
hmo
Standard
claim
breach of confidential communication
12. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
open panel HMO
(COBRA)
complience plan
ee schedule
13. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
subscriber
Coordinated Coverage
referral
crossover claim
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
confidentiality
consulting physician
(PCP) Primary Care Physician
claim
15. 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
disclosure
Pre-certification
HIPAA
16. 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.
ppo
preauthorization
security officer
etiquette
17. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
crossover claim
electronic media
ethics
deductible
18. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
Specialist
(ERISA) Employee Retirement Income Security Act of 1974
epo
Out of Network (OON)
19. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(DRG's)
Deductible
ordering physician
Experimental Procedures
20. 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
epo
deductible
self-referral
Sub-acute Care
21. A rule - condition - or requirement
covered entity
(TPA) Third Party Administrator
(PAC) Pre- Admission Certification
Standard
22. The amount of actual money available to the medical practice
cash flow
Subscriber
Preauthorization
prepaid plan
23. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
AMA
consent
preauthorization
Out of Network (OON)
24. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(OOPs) Out of Pocket Costs/Expenses
Amblatory Care
claim
Allowed Expenses
25. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
ordering physician
Individually identifiable health information
state preemption
26. The dates of healthcare services were provided to the beneficiary
referring physician
Specialist
(DOS) Date of Service
(APC) Ambulatory Patient Classifications
27. American Medical Association
(PEC) Pre-existing condition
AMA
abuse
cash flow
28. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
disclosure
premium
(UR) Utilization review
closed panel HMO
29. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Specialist
Protected health information
(TPA) Third Party Administrator
preauthorization
30. 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
epo
(PCP) Primary Care Physician
(Non-par) Non-Participating Provider
Specialist
31. Individually identifiable health information
business associate
referring physician
IIHI
(OOPs) Out of Pocket Costs/Expenses
32. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Experimental Procedures
ee schedule
referring physician
33. Is a provider who sends the patients for testing or treatment
Maximum Out Of Pocket
referring physician
(DOS) Date of Service
Claim
34. Coverage for the treatment obtained from a non-participating provider. Typically - it requires payment of a deductible and higher co-payments and co-insurance than for treatment from a participating provider
Network
(PCP) Primary Care Physician
Supplementary Medical Insurance
Out of Network (OON)
35. A health insurance enrollee chooses to see an out of network provider without authorization
open panel HMO
Network
HIPAA
self-referral
36. 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.
confidentiality
benefit period
(TPA) Third Party Administrator
security officer
37. 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
Embezzlement
Referral
crossover claim
38. 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
Sub-acute Care
(ABN) Advance Beneficiary Notice
Treating or performing physician
e-health information management
39. 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
(PPS) Hospital Impatient Prospective Payment System
pos
cash flow
Consent form
40. 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.
premium
Notice of Privacy Practices
Coordinated Coverage
Specialist
41. An intentional misrepresentation of the facts to deceive or mislead another.
attending physician
fraud
Out of Network (OON)
HIPAA
42. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
state preemption
claim
(UCR) Usual - Customary and Reasonable
preauthorization
43. 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)
Consent form
(AOB) Assignment of Benefits
Assignment & Authorization
medical foundation
44. A structure for classifying outpatient services and procedures for purpose of payment
Beneficiary
state preemption
(ABN) Advance Beneficiary Notice
(APC) Ambulatory Patient Classifications
45. 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
Security Rule
Experimental Procedures
(Non-par) Non-Participating Provider
open panel HMO
46. A monthly fee paid by the insured for specific medical insurance coverage
(APC) Ambulatory Patient Classifications
Allowed Expenses
Preauthorization
premium
47. 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.
(UCR) Usual - Customary and Reasonable
business associate
(COBRA)
HIPAA
48. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
Network
Open Enrollment
abuse
ids
49. A willful act by an employee of taking possession of an employer's money
Embezzlement
(POS) Point-of Service Plan
state preemption
Supplementary Medical Insurance
50. The transmission of information between two parties to carry out financial or administrative activities related to health care.
referring physician
transaction
cash flow
(PCP) Primary Care Physician