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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. 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
AMA
Privacy officer
Standard
(DME) Durable Medical Equipment
2. A monthly fee paid by the insured for specific medical insurance coverage
Claim
(COBRA)
Standard
premium
3. 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
Allowed Expenses
pos
ids
4. Medical staff member who is legally responsible for the care and treatment given to a patient.
complience plan
attending physician
open panel HMO
Claim
5. An organization of provider sites with a contracted relationship that offer services
self-referral
Out of Network (OON)
phantom billing
ids
6. Health Information Portability and Accountability Act
(COBRA)
HIPAA
Specialist
pos
7. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Open Enrollment
attending physician
confidentiality
Coordinated Coverage
8. 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
HIPAA
disclosure
(POS) Point-of Service Plan
9. Unauthorized release of information
electronic media
(PCP) Primary Care Physician
security officer
breach of confidential communication
10. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Standard
referring physician
clearinghouse
prepaid plan
11. 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.
Embezzlement
(TPA) Third Party Administrator
pcp
Privileged information
12. A review of the need for inpatient hospital care - completed before the actual admission
business associate
Amblatory Care
(PAC) Pre- Admission Certification
Protected health information
13. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
ppo
ethics
(ABN) Advance Beneficiary Notice
Resonable Charge
14. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(UCR) Usual - Customary and Reasonable
Privileged information
Referral
complience plan
15. 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
ee schedule
(ERISA) Employee Retirement Income Security Act of 1974
self-referral
16. Medicare's method of paying acute care hospitals for inpatient care
Individually identifiable health information
(POS) Point-of Service Plan
(PPS) Hospital Impatient Prospective Payment System
fraud
17. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
deductible
(PCP) Primary Care Physician
Pre-existing Condition Exclusion
18. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
premium
transaction
Treating or performing physician
Network
19. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
(PCN) Primary Care Network
pos
HIPAA
20. 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
e-health information management
epo
Out of Network (OON)
Individually identifiable health information
21. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
premium
Sub-acute Care
claim
Treating or performing physician
22. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
consulting physician
(POS) Point-of Service Plan
Specialist
23. 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
Coordinated Coverage
Pre-existing Condition Exclusion
Security Rule
ee schedule
24. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
(DRG's)
(DOS) Date of Service
e-health information management
Assignment & Authorization
25. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
confidentiality
ethics
pcp
Embezzlement
26. Medical staff member who is legally responsible for the care and treatment given to a patient.
fraud
attending physician
Standard
consulting physician
27. Individually identifiable health information
IIHI
privacy
Protected health information
Privacy officer
28. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
(EPO) Exclusive Provider Organization
security officer
Treating or performing physician
29. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Assignment & Authorization
(COBRA)
pcp
(UR) Utilization review
30. 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
health care provider
covered entity
ppo
ordering physician
31. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Confidential communication
econdary Payer
Notice of Privacy Practices
hmo
32. 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
Resonable Charge
clearinghouse
(OOPs) Out of Pocket Costs/Expenses
33. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Pre-existing Condition Exclusion
Claim
Referral
Specialist
34. A clinic that is owned by the HMO and the physicians are employees of the HMO
pos
closed panel HMO
authorization form
Privacy officer
35. 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.
health care provider
Privacy officer
covered entity
Standard
36. An intentional misrepresentation of the facts to deceive or mislead another.
(UCR) Usual - Customary and Reasonable
Privileged information
(AOB) Assignment of Benefits
fraud
37. 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
Confidential communication
(COBRA)
(DME) Durable Medical Equipment
Out of Network (OON)
38. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Individually identifiable health information
(TPA) Third Party Administrator
(DRG's)
Participating Provider
39. A rule - condition - or requirement
ppo
health care provider
Standard
referral
40. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
disclosure
(PEC) Pre-existing condition
epo
claim
41. 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
ethics
(POS) Point-of Service Plan
Preauthorization
Deductible
42. A structure for classifying outpatient services and procedures for purpose of payment
open panel HMO
(APC) Ambulatory Patient Classifications
(DME) Durable Medical Equipment
Protected health information
43. 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
self-referral
epo
crossover claim
Privacy officer
44. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
e-health information management
Embezzlement
hmo
45. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
Medigap Insurance
benefit period
etiquette
46. American Medical Association
AMA
attending physician
prepaid plan
Covered Expenses
47. 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
ppo
complience plan
prepaid plan
security officer
48. A monthly fee paid by the insured for specific medical insurance coverage
premium
(PCN) Primary Care Network
business associate
(DRG's)
49. The maximum amount a plan pays for a covered service
Allowed Expenses
authorization form
(AOB) Assignment of Benefits
Treating or performing physician
50. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
cash flow
complience
business associate
Protected health information