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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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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. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
state preemption
ppo
hmo
(PAC) Pre- Admission Certification
2. A nonprofit integrated delivery system
covered entity
medical foundation
(Non-par) Non-Participating Provider
pos
3. Integrating benefits payable under more than one health insurance.
Assignment & Authorization
(OOPs) Out of Pocket Costs/Expenses
Coordinated Coverage
ee schedule
4. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(PPS) Hospital Impatient Prospective Payment System
Privacy officer
electronic media
HIPAA
5. Customs - rules of conduct - courtesy - and manners of the medical profession
IIHI
etiquette
Deductible
(PAC) Pre- Admission Certification
6. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Resonable Charge
Medigap Insurance
Security Rule
Deductible
7. Is a provider who sends the patients for testing or treatment
security officer
referring physician
ee schedule
Notice of Privacy Practices
8. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
referral
(UCR) Usual - Customary and Reasonable
Embezzlement
(UR) Utilization review
9. A practice of some health insurers to deny coverage to individuals for a certain period for health conditions that already exist when coverage is initiated
Amblatory Care
Privileged information
Pre-existing Condition Exclusion
AMA
10. 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
Claim
Resonable Charge
Privacy officer
11. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Protected health information
Referral
ordering physician
claim
12. 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
(UR) Utilization review
(Non-par) Non-Participating Provider
consulting physician
subscriber
13. 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.
Beneficiary
ppo
ethics
Privacy officer
14. The amount of actual money available to the medical practice
(UCR) Usual - Customary and Reasonable
pcp
Coordinated Coverage
cash flow
15. Health Information Portability and Accountability Act
Confidential communication
Deductible
HIPAA
Allowed Expenses
16. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(DOS) Date of Service
benefit period
Resonable Charge
referral
17. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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18. Is a provider who sends the patients for testing or treatment
Open Enrollment
(PCP) Primary Care Physician
referring physician
(PPS) Hospital Impatient Prospective Payment System
19. Individually identifiable health information
Amblatory Care
consent
self-referral
IIHI
20. Medical services provided on an outpatient basis
Amblatory Care
Treating or performing physician
open panel HMO
hmo
21. 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
electronic media
Maximum Out Of Pocket
health care provider
open panel HMO
22. A structure for classifying outpatient services and procedures for purpose of payment
transaction
phantom billing
(APC) Ambulatory Patient Classifications
referring physician
23. 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
Beneficiary
Supplementary Medical Insurance
Allowed Expenses
ppo
24. 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
abuse
premium
(ERISA) Employee Retirement Income Security Act of 1974
deductible
25. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
medical foundation
Experimental Procedures
complience
closed panel HMO
26. A rule - condition - or requirement
HIPAA
Standard
(DRG's)
e-health information management
27. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Deductible
Network
AMA
Referral
28. An organization of provider sites with a contracted relationship that offer services
(UR) Utilization review
ids
Referral
Assignment & Authorization
29. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
HIPAA
(DME) Durable Medical Equipment
deductible
Confidential communication
30. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Standard
referring physician
covered entity
Individually identifiable health information
31. Someone who is eligible for or receiving benefits under an insurance policy or plan
clearinghouse
Beneficiary
Network
Amblatory Care
32. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Referral
(POS) Point-of Service Plan
(UCR) Usual - Customary and Reasonable
33. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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34. A monthly fee paid by the insured for specific medical insurance coverage
(APC) Ambulatory Patient Classifications
(DCI) Duplicate Coverage Inquiry
premium
ordering physician
35. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Assignment & Authorization
phantom billing
Sub-acute Care
Medigap Insurance
36. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
epo
(ABN) Advance Beneficiary Notice
(OOPs) Out of Pocket Costs/Expenses
consulting physician
37. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
(PCP) Primary Care Physician
pos
open panel HMO
38. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
complience plan
Specialist
Deductible
39. 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.
abuse
electronic media
(TPA) Third Party Administrator
Notice of Privacy Practices
40. 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
Open Enrollment
econdary Payer
Covered Expenses
(PCP) Primary Care Physician
41. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Maximum Out Of Pocket
subscriber
claim
(DCI) Duplicate Coverage Inquiry
42. 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
(POS) Point-of Service Plan
Pre-certification
attending physician
43. 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
(COB) Coordination of Benefits
(ABN) Advance Beneficiary Notice
(Non-par) Non-Participating Provider
etiquette
44. 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.
complience
business associate
ethics
phantom billing
45. A list of the amount to be paid by an insurance company for each procedure service
Specialist
Coordinated Coverage
ee schedule
open panel HMO
46. Medical staff member who is legally responsible for the care and treatment given to a patient.
(COB) Coordination of Benefits
(OOPs) Out of Pocket Costs/Expenses
attending physician
ee schedule
47. 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
Consent form
(DCI) Duplicate Coverage Inquiry
Network
48. 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
Medigap Insurance
(PEC) Pre-existing condition
epo
phantom billing
49. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
deductible
confidentiality
Security Rule
Pre-existing Condition Exclusion
50. What the insurance company will consider paying for as defined in the contract.
Sub-acute Care
Covered Expenses
(ABN) Advance Beneficiary Notice
Referral
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