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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. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
ppo
(OOPs) Out of Pocket Costs/Expenses
(AOB) Assignment of Benefits
Protected health information
2. 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.
state preemption
crossover claim
covered entity
(PCP) Primary Care Physician
3. The dates of healthcare services were provided to the beneficiary
(DRG's)
(AOB) Assignment of Benefits
(DOS) Date of Service
nonprivileged information
4. 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
electronic media
Assignment & Authorization
(COBRA)
Preauthorization
5. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Claim
Specialist
Coordinated Coverage
ordering physician
6. A monthly fee paid by the insured for specific medical insurance coverage
premium
(ERISA) Employee Retirement Income Security Act of 1974
self-referral
etiquette
7. 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.
Privileged information
(Non-par) Non-Participating Provider
health care provider
consent
8. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
subscriber
Claim
Experimental Procedures
e-health information management
9. A willful act by an employee of taking possession of an employer's money
Embezzlement
Preauthorization
pcp
(DME) Durable Medical Equipment
10. A group of physicians or other health care providers who have a contractual agreement to provide services to subscribers on a negotiated fee-for-services or capitated basis
(PCN) Primary Care Network
Coordinated Coverage
Consent form
prepaid plan
11. 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
(DME) Durable Medical Equipment
Confidential communication
disclosure
(PCN) Primary Care Network
12. 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
complience
Supplementary Medical Insurance
confidentiality
(PPS) Hospital Impatient Prospective Payment System
13. The transmission of information between two parties to carry out financial or administrative activities related to health care.
disclosure
transaction
Protected health information
privacy
14. 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
subscriber
(POS) Point-of Service Plan
(COB) Coordination of Benefits
covered entity
15. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
covered entity
Treating or performing physician
Privacy officer
16. 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
(PPS) Hospital Impatient Prospective Payment System
business associate
IIHI
open panel HMO
17. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Sub-acute Care
hmo
preauthorization
Open Enrollment
18. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
complience plan
covered entity
phantom billing
Subscriber
19. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
benefit period
complience plan
nonprivileged information
20. What the insurance company will consider paying for as defined in the contract.
(OOPs) Out of Pocket Costs/Expenses
ordering physician
e-health information management
Covered Expenses
21. 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
Open Enrollment
(UCR) Usual - Customary and Reasonable
Network
health care provider
22. Health Information Portability and Accountability Act
Pre-existing Condition Exclusion
confidentiality
(TPA) Third Party Administrator
HIPAA
23. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
ee schedule
IIHI
attending physician
24. A review of the need for inpatient hospital care - completed before the actual admission
abuse
(OOPs) Out of Pocket Costs/Expenses
(PAC) Pre- Admission Certification
disclosure
25. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Subscriber
preauthorization
hmo
ordering physician
26. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
Covered Expenses
breach of confidential communication
Participating Provider
27. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
covered entity
IIHI
breach of confidential communication
Network
28. The dates of healthcare services were provided to the beneficiary
benefit period
(DOS) Date of Service
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
29. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
abuse
(EPO) Exclusive Provider Organization
Network
cash flow
30. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
prepaid plan
Claim
abuse
31. 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.
closed panel HMO
closed panel HMO
self-referral
Privileged information
32. 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
ethics
Referral
claim
Pre-existing Condition Exclusion
33. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
subscriber
etiquette
(UR) Utilization review
transaction
34. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
confidentiality
Maximum Out Of Pocket
hmo
preauthorization
35. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Confidential communication
Preauthorization
(OOPs) Out of Pocket Costs/Expenses
Referral
36. 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
epo
Network
(TPA) Third Party Administrator
37. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
deductible
(ERISA) Employee Retirement Income Security Act of 1974
(TPA) Third Party Administrator
claim
38. 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
complience plan
IIHI
(PPS) Hospital Impatient Prospective Payment System
39. The condition of being secluded from the presence or view of others.
HIPAA
nonprivileged information
privacy
(POS) Point-of Service Plan
40. 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
phantom billing
epo
Referral
41. A health insurance enrollee chooses to see an out of network provider without authorization
open panel HMO
Beneficiary
self-referral
Medigap Insurance
42. 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.
medical foundation
state preemption
complience plan
AMA
43. A nonprofit integrated delivery system
etiquette
medical foundation
Assignment & Authorization
Supplementary Medical Insurance
44. Billing for services not performed
(AOB) Assignment of Benefits
IIHI
phantom billing
(PAC) Pre- Admission Certification
45. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Amblatory Care
(PCP) Primary Care Physician
pcp
referral
46. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Privileged information
abuse
Notice of Privacy Practices
Confidential communication
47. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
econdary Payer
IIHI
Participating Provider
Supplementary Medical Insurance
48. 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
breach of confidential communication
Out of Network (OON)
(OOPs) Out of Pocket Costs/Expenses
(AOB) Assignment of Benefits
49. 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
Referral
abuse
Preauthorization
Supplementary Medical Insurance
50. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Standard
complience
Specialist
deductible
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