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. A clinic that is owned by the HMO and the physicians are employees of the HMO
(UR) Utilization review
closed panel HMO
(TPA) Third Party Administrator
(PCN) Primary Care Network
2. 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
covered entity
Notice of Privacy Practices
(DME) Durable Medical Equipment
privacy
3. 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
Security Rule
Referral
Maximum Out Of Pocket
Sub-acute Care
4. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
(Non-par) Non-Participating Provider
covered entity
deductible
5. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Experimental Procedures
(UCR) Usual - Customary and Reasonable
privacy
Supplementary Medical Insurance
6. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Embezzlement
Subscriber
(PAC) Pre- Admission Certification
Confidential communication
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.
econdary Payer
(DRG's)
Open Enrollment
clearinghouse
8. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
abuse
deductible
(DCI) Duplicate Coverage Inquiry
Individually identifiable health information
9. 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
Medigap Insurance
Protected health information
pos
Beneficiary
10. What the insurance company will consider paying for as defined in the contract.
(PPS) Hospital Impatient Prospective Payment System
ids
Covered Expenses
(COBRA)
11. 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
electronic media
(TPA) Third Party Administrator
prepaid plan
Assignment & Authorization
12. A nonprofit integrated delivery system
HIPAA
medical foundation
epo
benefit period
13. 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
(POS) Point-of Service Plan
Sub-acute Care
transaction
Beneficiary
14. The condition of being secluded from the presence or view of others.
fraud
(DCI) Duplicate Coverage Inquiry
Deductible
privacy
15. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Out of Network (OON)
Pre-existing Condition Exclusion
ordering physician
transaction
16. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Out of Network (OON)
Individually identifiable health information
closed panel HMO
ethics
17. 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
Assignment & Authorization
electronic media
abuse
(AOB) Assignment of Benefits
18. 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)
ethics
phantom billing
Consent form
Preauthorization
19. 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
complience
(DOS) Date of Service
privacy
20. 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
(AOB) Assignment of Benefits
ids
open panel HMO
21. Medical services provided on an outpatient basis
medical foundation
Amblatory Care
Treating or performing physician
Notice of Privacy Practices
22. 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
ids
Sub-acute Care
(Non-par) Non-Participating Provider
Pre-existing Condition Exclusion
23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
referring physician
Beneficiary
closed panel HMO
Specialist
24. 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
business associate
(DME) Durable Medical Equipment
covered entity
Experimental Procedures
25. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
crossover claim
e-health information management
Notice of Privacy Practices
hmo
26. 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
hmo
open panel HMO
(PCN) Primary Care Network
Out of Network (OON)
27. 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
ordering physician
(APC) Ambulatory Patient Classifications
ppo
(PCN) Primary Care Network
28. The dates of healthcare services were provided to the beneficiary
claim
Referral
(DOS) Date of Service
fraud
29. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
ppo
closed panel HMO
Pre-certification
30. The amount of actual money available to the medical practice
crossover claim
cash flow
attending physician
ethics
31. Billing for services not performed
phantom billing
authorization form
e-health information management
clearinghouse
32. Verbal or written agreement that gives approval to some action - situation - or statement.
ppo
Maximum Out Of Pocket
consent
preauthorization
33. 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
Assignment & Authorization
econdary Payer
Security Rule
e-health information management
34. A review of the need for inpatient hospital care - completed before the actual admission
Beneficiary
Covered Expenses
closed panel HMO
(PAC) Pre- Admission Certification
35. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
ee schedule
ee schedule
nonprivileged information
transaction
36. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(COBRA)
ids
Out of Network (OON)
pcp
37. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
disclosure
(DRG's)
(DOS) Date of Service
claim
38. A health insurance enrollee chooses to see an out of network provider without authorization
HIPAA
self-referral
(Non-par) Non-Participating Provider
(APC) Ambulatory Patient Classifications
39. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Privacy officer
(PEC) Pre-existing condition
econdary Payer
(UR) Utilization review
40. Approval or consent by a primary physician for patient referral to ancillary services and specialists
claim
Referral
Allowed Expenses
Embezzlement
41. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
consent
(PEC) Pre-existing condition
(COB) Coordination of Benefits
42. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Experimental Procedures
AMA
Specialist
(DCI) Duplicate Coverage Inquiry
43. A willful act by an employee of taking possession of an employer's money
Embezzlement
Medigap Insurance
Security Rule
electronic media
44. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
phantom billing
Beneficiary
Pre-certification
preauthorization
45. 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
(Non-par) Non-Participating Provider
Treating or performing physician
Allowed Expenses
46. 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.
state preemption
benefit period
(PCN) Primary Care Network
business associate
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
Specialist
econdary Payer
attending physician
abuse
48. A privileged communication that may be disclosed only with the patient's permission.
Claim
premium
Subscriber
Confidential communication
49. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
Resonable Charge
Pre-existing Condition Exclusion
medical foundation
50. 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
Confidential communication
Protected health information
closed panel HMO