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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. Integrating benefits payable under more than one health insurance.
authorization form
complience plan
Coordinated Coverage
benefit period
2. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
breach of confidential communication
phantom billing
(PEC) Pre-existing condition
claim
3. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Resonable Charge
Subscriber
state preemption
(PCP) Primary Care Physician
4. Customs - rules of conduct - courtesy - and manners of the medical profession
(DRG's)
Deductible
etiquette
(OOPs) Out of Pocket Costs/Expenses
5. 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
(COB) Coordination of Benefits
Experimental Procedures
consulting physician
fraud
6. A group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
subscriber
(PCN) Primary Care Network
(DCI) Duplicate Coverage Inquiry
business associate
7. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
breach of confidential communication
Pre-existing Condition Exclusion
Participating Provider
subscriber
8. Medicare's method of paying acute care hospitals for inpatient care
Coordinated Coverage
ids
(PPS) Hospital Impatient Prospective Payment System
(COB) Coordination of Benefits
9. American Medical Association
AMA
phantom billing
attending physician
epo
10. 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
(TPA) Third Party Administrator
ppo
Open Enrollment
Claim
11. 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
Pre-existing Condition Exclusion
breach of confidential communication
Embezzlement
Protected health information
12. 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.
IIHI
ids
confidentiality
Notice of Privacy Practices
13. A provision that apples when a person is covered under more than one group medical program
Claim
(COB) Coordination of Benefits
(ABN) Advance Beneficiary Notice
clearinghouse
14. 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.
business associate
Referral
Subscriber
(PPS) Hospital Impatient Prospective Payment System
15. Customs - rules of conduct - courtesy - and manners of the medical profession
(TPA) Third Party Administrator
etiquette
Individually identifiable health information
Assignment & Authorization
16. A privileged communication that may be disclosed only with the patient's permission.
Covered Expenses
Referral
Confidential communication
e-health information management
17. 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
cash flow
Security Rule
premium
open panel HMO
18. 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
(POS) Point-of Service Plan
deductible
(PEC) Pre-existing condition
Supplementary Medical Insurance
19. 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.
(PCP) Primary Care Physician
crossover claim
Sub-acute Care
Privacy officer
20. 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
security officer
crossover claim
hmo
21. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
electronic media
Specialist
Maximum Out Of Pocket
22. 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.
Beneficiary
health care provider
security officer
clearinghouse
23. A clinic that is owned by the HMO and the physicians are employees of the HMO
Open Enrollment
(COBRA)
closed panel HMO
preauthorization
24. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
electronic media
e-health information management
IIHI
(ERISA) Employee Retirement Income Security Act of 1974
25. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
phantom billing
(COB) Coordination of Benefits
(Non-par) Non-Participating Provider
pcp
26. 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
(AOB) Assignment of Benefits
pos
abuse
Beneficiary
27. Individually identifiable health information
etiquette
ethics
AMA
IIHI
28. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
privacy
subscriber
complience plan
IIHI
29. 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.
medical foundation
attending physician
premium
security officer
30. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Allowed Expenses
cash flow
Protected health information
Deductible
31. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
subscriber
Confidential communication
disclosure
32. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Consent form
(UR) Utilization review
Medigap Insurance
Pre-certification
33. What the insurance company will consider paying for as defined in the contract.
deductible
Covered Expenses
complience
(TPA) Third Party Administrator
34. 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
consulting physician
prepaid plan
(EPO) Exclusive Provider Organization
Maximum Out Of Pocket
35. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Deductible
subscriber
ppo
Specialist
36. A nonprofit integrated delivery system
deductible
Maximum Out Of Pocket
medical foundation
Claim
37. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Participating Provider
(UR) Utilization review
Preauthorization
medical foundation
38. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
subscriber
Claim
Medigap Insurance
disclosure
39. 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
ethics
Supplementary Medical Insurance
Sub-acute Care
crossover claim
40. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
AMA
Resonable Charge
e-health information management
ee schedule
41. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
open panel HMO
(TPA) Third Party Administrator
Notice of Privacy Practices
42. 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
closed panel HMO
complience
(ERISA) Employee Retirement Income Security Act of 1974
covered entity
43. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
Privileged information
ee schedule
complience plan
44. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
covered entity
confidentiality
(ABN) Advance Beneficiary Notice
epo
45. Integrating benefits payable under more than one health insurance.
preauthorization
(DOS) Date of Service
(DOS) Date of Service
Coordinated Coverage
46. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Preauthorization
Individually identifiable health information
state preemption
Out of Network (OON)
47. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
ids
(AOB) Assignment of Benefits
Pre-existing Condition Exclusion
(TPA) Third Party Administrator
48. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Individually identifiable health information
(OOPs) Out of Pocket Costs/Expenses
(EPO) Exclusive Provider Organization
Confidential communication
49. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
pcp
Network
IIHI
(AOB) Assignment of Benefits
50. 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
Security Rule
nonprivileged information
(PCP) Primary Care Physician
Standard