SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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. 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
(COB) Coordination of Benefits
HIPAA
premium
Out of Network (OON)
2. Standards of conduct generally accepted as a moral guide for behavior.
Sub-acute Care
ethics
Beneficiary
(COB) Coordination of Benefits
3. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
etiquette
(POS) Point-of Service Plan
subscriber
4. 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
referring physician
(ABN) Advance Beneficiary Notice
etiquette
Open Enrollment
5. The transmission of information between two parties to carry out financial or administrative activities related to health care.
pos
transaction
(APC) Ambulatory Patient Classifications
complience plan
6. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(ABN) Advance Beneficiary Notice
disclosure
referral
Medigap Insurance
7. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
premium
Notice of Privacy Practices
(COB) Coordination of Benefits
8. 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
deductible
hmo
Referral
9. What the insurance company will consider paying for as defined in the contract.
open panel HMO
AMA
Covered Expenses
complience
10. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
confidentiality
attending physician
IIHI
11. 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
phantom billing
Security Rule
(PCN) Primary Care Network
subscriber
12. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
complience plan
Supplementary Medical Insurance
ethics
electronic media
13. The maximum amount a plan pays for a covered service
Coordinated Coverage
econdary Payer
Allowed Expenses
attending physician
14. 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
(UR) Utilization review
(COBRA)
(POS) Point-of Service Plan
Medigap Insurance
15. Unauthorized release of information
pcp
(DME) Durable Medical Equipment
(PEC) Pre-existing condition
breach of confidential communication
16. A rule - condition - or requirement
etiquette
Privileged information
Standard
Coordinated Coverage
17. 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.
(APC) Ambulatory Patient Classifications
ids
Privacy officer
nonprivileged information
18. 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
(PCN) Primary Care Network
Assignment & Authorization
(APC) Ambulatory Patient Classifications
Privacy officer
19. 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
pos
(APC) Ambulatory Patient Classifications
(UCR) Usual - Customary and Reasonable
Participating Provider
20. Health Information Portability and Accountability Act
HIPAA
complience
claim
open panel HMO
21. 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
Standard
complience plan
authorization form
clearinghouse
22. A list of the amount to be paid by an insurance company for each procedure service
hmo
ee schedule
prepaid plan
complience
23. Integrating benefits payable under more than one health insurance.
(EPO) Exclusive Provider Organization
attending physician
epo
Coordinated Coverage
24. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Amblatory Care
(ERISA) Employee Retirement Income Security Act of 1974
Standard
25. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
Pre-certification
pcp
Preauthorization
26. The transmission of information between two parties to carry out financial or administrative activities related to health care.
breach of confidential communication
(DRG's)
ordering physician
transaction
27. Is the provider who renders a service to a patient
consulting physician
(EPO) Exclusive Provider Organization
Standard
Treating or performing physician
28. 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
Maximum Out Of Pocket
attending physician
(Non-par) Non-Participating Provider
(AOB) Assignment of Benefits
29. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Privacy officer
disclosure
Participating Provider
30. 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
complience plan
Out of Network (OON)
benefit period
ppo
31. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Embezzlement
Security Rule
(TPA) Third Party Administrator
32. 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.
Pre-existing Condition Exclusion
Standard
(APC) Ambulatory Patient Classifications
Privileged information
33. 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.
(APC) Ambulatory Patient Classifications
referring physician
business associate
preauthorization
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
Specialist
closed panel HMO
Maximum Out Of Pocket
prepaid plan
35. The period of time that payment for Medicare inpatient hospital benefits are available
Standard
Privacy officer
Preauthorization
benefit period
36. 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
authorization form
Participating Provider
Network
(DCI) Duplicate Coverage Inquiry
37. A monthly fee paid by the insured for specific medical insurance coverage
Preauthorization
premium
epo
authorization form
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
attending physician
medical foundation
(DCI) Duplicate Coverage Inquiry
subscriber
39. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Allowed Expenses
Consent form
(DOS) Date of Service
Resonable Charge
40. 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
Out of Network (OON)
pcp
ethics
Assignment & Authorization
41. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(PCN) Primary Care Network
preauthorization
abuse
Resonable Charge
42. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
authorization form
(UCR) Usual - Customary and Reasonable
business associate
(PCN) Primary Care Network
43. 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.
medical foundation
Medigap Insurance
Notice of Privacy Practices
Supplementary Medical Insurance
44. A review of the need for inpatient hospital care - completed before the actual admission
preauthorization
state preemption
pcp
(PAC) Pre- Admission Certification
45. An organization of provider sites with a contracted relationship that offer services
Security Rule
(DME) Durable Medical Equipment
ids
(PEC) Pre-existing condition
46. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(COB) Coordination of Benefits
crossover claim
Amblatory Care
(OOPs) Out of Pocket Costs/Expenses
47. A privileged communication that may be disclosed only with the patient's permission.
deductible
Confidential communication
Embezzlement
state preemption
48. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment
(DME) Durable Medical Equipment
attending physician
(POS) Point-of Service Plan
Confidential communication
49. 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
Sub-acute Care
econdary Payer
attending physician
(ERISA) Employee Retirement Income Security Act of 1974
50. 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
clearinghouse
ids
pcp