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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. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Resonable Charge
(EPO) Exclusive Provider Organization
(DOS) Date of Service
2. 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
epo
Covered Expenses
security officer
3. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Open Enrollment
preauthorization
ordering physician
(Non-par) Non-Participating Provider
4. 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
(DRG's)
security officer
IIHI
open panel HMO
5. 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
closed panel HMO
(Non-par) Non-Participating Provider
authorization form
6. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Supplementary Medical Insurance
prepaid plan
econdary Payer
7. A rule - condition - or requirement
Standard
phantom billing
state preemption
closed panel HMO
8. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(POS) Point-of Service Plan
fraud
Covered Expenses
pcp
9. 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
abuse
(Non-par) Non-Participating Provider
breach of confidential communication
consulting physician
10. 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.
security officer
Claim
Privileged information
(DRG's)
11. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
crossover claim
(DME) Durable Medical Equipment
clearinghouse
Participating Provider
12. 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
Open Enrollment
business associate
(UCR) Usual - Customary and Reasonable
(ERISA) Employee Retirement Income Security Act of 1974
13. 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
IIHI
business associate
Treating or performing physician
Assignment & Authorization
14. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
epo
Out of Network (OON)
ppo
referral
15. 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
attending physician
benefit period
ppo
16. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
pcp
(PPS) Hospital Impatient Prospective Payment System
e-health information management
Medigap Insurance
17. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
Amblatory Care
referral
Resonable Charge
18. Is a provider who sends the patients for testing or treatment
Pre-certification
referring physician
Sub-acute Care
econdary Payer
19. 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
Pre-existing Condition Exclusion
Experimental Procedures
(DCI) Duplicate Coverage Inquiry
20. 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
pos
Beneficiary
open panel HMO
transaction
21. The amount of actual money available to the medical practice
Specialist
cash flow
Medigap Insurance
referral
22. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(DME) Durable Medical Equipment
Privacy officer
ordering physician
Network
23. A document that is not required before physicians use or disclose protected health information for treatment - payment - or routine health care operations of the patient. (For other purposes - see Authorization form)
Experimental Procedures
cash flow
Consent form
referring physician
24. 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
(PPS) Hospital Impatient Prospective Payment System
cash flow
(APC) Ambulatory Patient Classifications
econdary Payer
25. American Medical Association
AMA
open panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
complience plan
26. 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
Specialist
Privacy officer
Beneficiary
(DME) Durable Medical Equipment
27. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Standard
(DRG's)
subscriber
abuse
28. Standards of conduct generally accepted as a moral guide for behavior.
(ERISA) Employee Retirement Income Security Act of 1974
pcp
ethics
Resonable Charge
29. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
econdary Payer
consent
claim
electronic media
30. The dates of healthcare services were provided to the beneficiary
breach of confidential communication
(DOS) Date of Service
Out of Network (OON)
(UCR) Usual - Customary and Reasonable
31. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
referral
confidentiality
ethics
(DME) Durable Medical Equipment
32. 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
Subscriber
(TPA) Third Party Administrator
Standard
(AOB) Assignment of Benefits
33. 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
confidentiality
ordering physician
Embezzlement
(ERISA) Employee Retirement Income Security Act of 1974
34. 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
AMA
disclosure
(PCP) Primary Care Physician
Referral
35. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
preauthorization
Referral
Consent form
36. 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
(COB) Coordination of Benefits
(UCR) Usual - Customary and Reasonable
(PCP) Primary Care Physician
Medigap Insurance
37. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
ids
attending physician
consent
complience plan
38. 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
complience plan
Experimental Procedures
claim
(PAC) Pre- Admission Certification
39. 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
Security Rule
epo
AMA
electronic media
40. 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
open panel HMO
(DCI) Duplicate Coverage Inquiry
authorization form
Specialist
41. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
ids
(PPS) Hospital Impatient Prospective Payment System
Experimental Procedures
(UR) Utilization review
42. 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
transaction
open panel HMO
Sub-acute Care
(DME) Durable Medical Equipment
43. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
crossover claim
epo
Preauthorization
44. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Referral
attending physician
security officer
45. Individually identifiable health information
IIHI
Supplementary Medical Insurance
(POS) Point-of Service Plan
medical foundation
46. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
health care provider
subscriber
Notice of Privacy Practices
(COB) Coordination of Benefits
47. 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.
health care provider
ppo
etiquette
Security Rule
48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
authorization form
abuse
preauthorization
subscriber
49. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
pcp
clearinghouse
Treating or performing physician
50. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(Non-par) Non-Participating Provider
Security Rule
Amblatory Care
consulting physician