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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. 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
Out of Network (OON)
health care provider
consent
premium
2. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
econdary Payer
Specialist
authorization form
(OOPs) Out of Pocket Costs/Expenses
3. 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
(DRG's)
Maximum Out Of Pocket
Sub-acute Care
Covered Expenses
4. 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
(DRG's)
Participating Provider
Privileged information
(APC) Ambulatory Patient Classifications
5. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Covered Expenses
complience plan
attending physician
privacy
6. Customs - rules of conduct - courtesy - and manners of the medical profession
(DOS) Date of Service
Privacy officer
(COBRA)
etiquette
7. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
phantom billing
covered entity
(APC) Ambulatory Patient Classifications
8. A patient claim is eligible for medicare and medicaid
crossover claim
(PPS) Hospital Impatient Prospective Payment System
disclosure
(PCP) Primary Care Physician
9. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
nonprivileged information
cash flow
(DME) Durable Medical Equipment
Medigap Insurance
10. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
Assignment & Authorization
electronic media
Resonable Charge
(APC) Ambulatory Patient Classifications
11. Medicare's method of paying acute care hospitals for inpatient care
Embezzlement
open panel HMO
(PPS) Hospital Impatient Prospective Payment System
Privacy officer
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.
subscriber
Consent form
pos
Privileged information
13. 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.
(Non-par) Non-Participating Provider
clearinghouse
(ABN) Advance Beneficiary Notice
business associate
14. 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
Pre-certification
Open Enrollment
Pre-existing Condition Exclusion
authorization form
15. 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
consent
Allowed Expenses
prepaid plan
pos
16. 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.
premium
Protected health information
health care provider
(ERISA) Employee Retirement Income Security Act of 1974
17. What the insurance company will consider paying for as defined in the contract.
Pre-existing Condition Exclusion
Covered Expenses
Experimental Procedures
HIPAA
18. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
referring physician
self-referral
ordering physician
(UCR) Usual - Customary and Reasonable
19. A nonprofit integrated delivery system
pos
disclosure
medical foundation
electronic media
20. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Treating or performing physician
Pre-certification
(OOPs) Out of Pocket Costs/Expenses
(PPS) Hospital Impatient Prospective Payment System
21. 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)
Pre-certification
(ERISA) Employee Retirement Income Security Act of 1974
nonprivileged information
Consent form
22. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Resonable Charge
etiquette
(TPA) Third Party Administrator
Out of Network (OON)
23. Someone who is eligible for or receiving benefits under an insurance policy or plan
(COBRA)
(DOS) Date of Service
Participating Provider
Beneficiary
24. Individually identifiable health information
ee schedule
state preemption
premium
IIHI
25. 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.
Notice of Privacy Practices
Privacy officer
Protected health information
IIHI
26. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
ethics
Claim
Treating or performing physician
27. Medical services provided on an outpatient basis
Amblatory Care
Allowed Expenses
(PAC) Pre- Admission Certification
Standard
28. 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.
clearinghouse
security officer
e-health information management
IIHI
29. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Covered Expenses
fraud
Experimental Procedures
(UR) Utilization review
30. 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.
health care provider
Sub-acute Care
Notice of Privacy Practices
Out of Network (OON)
31. A rule - condition - or requirement
(TPA) Third Party Administrator
(PCN) Primary Care Network
Treating or performing physician
Standard
32. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Participating Provider
subscriber
Treating or performing physician
Allowed Expenses
33. 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
closed panel HMO
consulting physician
Pre-existing Condition Exclusion
34. 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
Open Enrollment
Experimental Procedures
IIHI
benefit period
35. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(DCI) Duplicate Coverage Inquiry
(COBRA)
IIHI
(UCR) Usual - Customary and Reasonable
36. 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
transaction
Confidential communication
(DCI) Duplicate Coverage Inquiry
pos
37. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
(AOB) Assignment of Benefits
HIPAA
(EPO) Exclusive Provider Organization
38. A nonprofit integrated delivery system
cash flow
medical foundation
(UR) Utilization review
Medigap Insurance
39. 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.
Pre-certification
business associate
Coordinated Coverage
benefit period
40. Individually identifiable health information
(COBRA)
Protected health information
IIHI
authorization form
41. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
disclosure
econdary Payer
confidentiality
(COB) Coordination of Benefits
42. Customs - rules of conduct - courtesy - and manners of the medical profession
preauthorization
business associate
deductible
etiquette
43. 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.
(UCR) Usual - Customary and Reasonable
(Non-par) Non-Participating Provider
claim
security officer
44. Is the provider who renders a service to a patient
hmo
Amblatory Care
Treating or performing physician
Specialist
45. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
referral
(UCR) Usual - Customary and Reasonable
complience plan
clearinghouse
46. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
hmo
ethics
(DRG's)
abuse
47. An intentional misrepresentation of the facts to deceive or mislead another.
(DCI) Duplicate Coverage Inquiry
abuse
Covered Expenses
fraud
48. An intentional misrepresentation of the facts to deceive or mislead another.
Subscriber
fraud
Resonable Charge
ids
49. 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
Privacy officer
(OOPs) Out of Pocket Costs/Expenses
(COB) Coordination of Benefits
50. 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
benefit period
(Non-par) Non-Participating Provider
Privacy officer