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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.
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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 hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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2. The transmission of information between two parties to carry out financial or administrative activities related to health care.
abuse
Preauthorization
ee schedule
transaction
3. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(DRG's)
Maximum Out Of Pocket
Privacy officer
(PEC) Pre-existing condition
4. 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
(PCN) Primary Care Network
prepaid plan
(DCI) Duplicate Coverage Inquiry
pos
5. 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
attending physician
(POS) Point-of Service Plan
econdary Payer
6. The amount of actual money available to the medical practice
fraud
health care provider
cash flow
Embezzlement
7. 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
Pre-existing Condition Exclusion
deductible
Protected health information
Sub-acute Care
8. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
IIHI
cash flow
Individually identifiable health information
(OOPs) Out of Pocket Costs/Expenses
9. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Referral
ordering physician
Claim
abuse
10. 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
(POS) Point-of Service Plan
complience plan
(COBRA)
Covered Expenses
11. 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.
disclosure
referring physician
ordering physician
health care provider
12. 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
Subscriber
(ERISA) Employee Retirement Income Security Act of 1974
(APC) Ambulatory Patient Classifications
(PAC) Pre- Admission Certification
13. A health insurance enrollee chooses to see an out of network provider without authorization
medical foundation
Consent form
self-referral
Deductible
14. Medicare's method of paying acute care hospitals for inpatient care
(DOS) Date of Service
health care provider
(PPS) Hospital Impatient Prospective Payment System
business associate
15. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Sub-acute Care
Preauthorization
claim
privacy
16. 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
(POS) Point-of Service Plan
Open Enrollment
ids
IIHI
17. 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.
Protected health information
electronic media
(POS) Point-of Service Plan
Supplementary Medical Insurance
18. 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
Claim
referring physician
open panel HMO
(PCP) Primary Care Physician
19. Standards of conduct generally accepted as a moral guide for behavior.
(OOPs) Out of Pocket Costs/Expenses
ethics
(COBRA)
hmo
20. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
complience
(PEC) Pre-existing condition
Medigap Insurance
Open Enrollment
21. What the insurance company will consider paying for as defined in the contract.
covered entity
Treating or performing physician
(AOB) Assignment of Benefits
Covered Expenses
22. 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.
Participating Provider
state preemption
hmo
(PPS) Hospital Impatient Prospective Payment System
23. A list of the amount to be paid by an insurance company for each procedure service
disclosure
consent
ee schedule
e-health information management
24. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Allowed Expenses
(OOPs) Out of Pocket Costs/Expenses
etiquette
Subscriber
25. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
pcp
hmo
pos
abuse
26. 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
Claim
privacy
Pre-certification
Maximum Out Of Pocket
27. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
(ABN) Advance Beneficiary Notice
referral
pos
28. A review of the need for inpatient hospital care - completed before the actual admission
Preauthorization
Experimental Procedures
(PAC) Pre- Admission Certification
open panel HMO
29. Billing for services not performed
Allowed Expenses
complience plan
covered entity
phantom billing
30. 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
health care provider
Embezzlement
Experimental Procedures
(PCN) Primary Care Network
31. 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
covered entity
pcp
(POS) Point-of Service Plan
Preauthorization
32. Unauthorized release of information
breach of confidential communication
econdary Payer
Protected health information
ppo
33. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Assignment & Authorization
(PAC) Pre- Admission Certification
abuse
Coordinated Coverage
34. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Out of Network (OON)
AMA
authorization form
e-health information management
35. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
breach of confidential communication
deductible
medical foundation
36. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
crossover claim
Network
(COBRA)
Privacy officer
37. 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
abuse
Assignment & Authorization
Deductible
nonprivileged information
38. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
transaction
ordering physician
closed panel HMO
(DCI) Duplicate Coverage Inquiry
39. 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.
pcp
security officer
Claim
(PPS) Hospital Impatient Prospective Payment System
40. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
electronic media
deductible
Notice of Privacy Practices
referral
41. The condition of being secluded from the presence or view of others.
privacy
(PCP) Primary Care Physician
crossover claim
Treating or performing physician
42. A patient claim is eligible for medicare and medicaid
business associate
(ERISA) Employee Retirement Income Security Act of 1974
crossover claim
Confidential communication
43. American Medical Association
AMA
nonprivileged information
health care provider
abuse
44. Billing for services not performed
nonprivileged information
privacy
phantom billing
Notice of Privacy Practices
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
(PCP) Primary Care Physician
(COB) Coordination of Benefits
(ABN) Advance Beneficiary Notice
Standard
46. 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
(COBRA)
(ABN) Advance Beneficiary Notice
Referral
Experimental Procedures
47. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
ppo
confidentiality
state preemption
covered entity
48. 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
deductible
self-referral
phantom billing
49. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
cash flow
confidentiality
(Non-par) Non-Participating Provider
50. Medical staff member who is legally responsible for the care and treatment given to a patient.
Resonable Charge
Specialist
e-health information management
attending physician
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