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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. Integrating benefits payable under more than one health insurance.
abuse
Deductible
Coordinated Coverage
confidentiality
2. 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
Participating Provider
(COBRA)
Consent form
Individually identifiable health information
3. 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
Assignment & Authorization
Open Enrollment
(PCP) Primary Care Physician
Sub-acute Care
4. Verbal or written agreement that gives approval to some action - situation - or statement.
state preemption
cash flow
Security Rule
consent
5. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
phantom billing
Individually identifiable health information
Referral
Notice of Privacy Practices
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
Subscriber
Pre-certification
Out of Network (OON)
Protected health information
7. 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.
AMA
(COB) Coordination of Benefits
confidentiality
business associate
8. 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
Amblatory Care
Maximum Out Of Pocket
(PAC) Pre- Admission Certification
pos
9. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
benefit period
Open Enrollment
preauthorization
(ABN) Advance Beneficiary Notice
10. An organization of provider sites with a contracted relationship that offer services
premium
Maximum Out Of Pocket
ids
benefit period
11. 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
epo
Pre-existing Condition Exclusion
(UCR) Usual - Customary and Reasonable
Beneficiary
12. A structure for classifying outpatient services and procedures for purpose of payment
disclosure
(ERISA) Employee Retirement Income Security Act of 1974
(APC) Ambulatory Patient Classifications
IIHI
13. Customs - rules of conduct - courtesy - and manners of the medical profession
Covered Expenses
(EPO) Exclusive Provider Organization
(DME) Durable Medical Equipment
etiquette
14. 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
nonprivileged information
closed panel HMO
covered entity
Supplementary Medical Insurance
15. A list of the amount to be paid by an insurance company for each procedure service
Allowed Expenses
Privileged information
ee schedule
Subscriber
16. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(PCP) Primary Care Physician
epo
(COB) Coordination of Benefits
Medigap Insurance
17. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Open Enrollment
claim
Preauthorization
ordering physician
18. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
referring physician
Resonable Charge
nonprivileged information
(DCI) Duplicate Coverage Inquiry
19. The maximum amount a plan pays for a covered service
Allowed Expenses
Privileged information
security officer
pos
20. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
deductible
crossover claim
hmo
Security Rule
21. 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
ppo
nonprivileged information
Treating or performing physician
(DCI) Duplicate Coverage Inquiry
22. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
state preemption
Supplementary Medical Insurance
Resonable Charge
abuse
23. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
business associate
(PAC) Pre- Admission Certification
benefit period
24. Billing for services not performed
hmo
phantom billing
(Non-par) Non-Participating Provider
Privacy officer
25. 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
transaction
consent
Participating Provider
(Non-par) Non-Participating Provider
26. 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
nonprivileged information
Coordinated Coverage
ee schedule
Security Rule
27. 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
authorization form
Specialist
Confidential communication
attending physician
28. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(PCP) Primary Care Physician
(UCR) Usual - Customary and Reasonable
Allowed Expenses
29. 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
clearinghouse
nonprivileged information
pos
ethics
30. 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.
Privacy officer
(COB) Coordination of Benefits
(UCR) Usual - Customary and Reasonable
pcp
31. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
disclosure
closed panel HMO
Network
32. 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.
electronic media
IIHI
Notice of Privacy Practices
subscriber
33. Individually identifiable health information
IIHI
Privacy officer
Treating or performing physician
Subscriber
34. 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
closed panel HMO
Sub-acute Care
(UR) Utilization review
Notice of Privacy Practices
35. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Preauthorization
(UR) Utilization review
(OOPs) Out of Pocket Costs/Expenses
Referral
36. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Maximum Out Of Pocket
referring physician
Individually identifiable health information
Resonable Charge
37. A nonprofit integrated delivery system
pos
privacy
medical foundation
Privileged information
38. The condition of being secluded from the presence or view of others.
privacy
consulting physician
Medigap Insurance
Referral
39. A provision that apples when a person is covered under more than one group medical program
Maximum Out Of Pocket
(COB) Coordination of Benefits
Open Enrollment
(ABN) Advance Beneficiary Notice
40. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(Non-par) Non-Participating Provider
covered entity
closed panel HMO
consulting physician
41. 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
open panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
Sub-acute Care
42. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Pre-certification
Network
medical foundation
43. A monthly fee paid by the insured for specific medical insurance coverage
(COBRA)
premium
claim
Deductible
44. An organization of provider sites with a contracted relationship that offer services
medical foundation
Protected health information
ids
confidentiality
45. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Referral
nonprivileged information
Open Enrollment
(PEC) Pre-existing condition
46. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
crossover claim
Medigap Insurance
Covered Expenses
47. The condition of being secluded from the presence or view of others.
closed panel HMO
consent
privacy
Allowed Expenses
48. 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.
open panel HMO
state preemption
Medigap Insurance
(DOS) Date of Service
49. 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
state preemption
(APC) Ambulatory Patient Classifications
(AOB) Assignment of Benefits
(DRG's)
50. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
pcp
abuse
Out of Network (OON)
Pre-certification