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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. 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
(ERISA) Employee Retirement Income Security Act of 1974
transaction
disclosure
etiquette
2. Individually identifiable health information
Sub-acute Care
pos
econdary Payer
IIHI
3. Verbal or written agreement that gives approval to some action - situation - or statement.
(COB) Coordination of Benefits
crossover claim
consent
security officer
4. A willful act by an employee of taking possession of an employer's money
preauthorization
Amblatory Care
Embezzlement
(DME) Durable Medical Equipment
5. An organization of provider sites with a contracted relationship that offer services
ids
disclosure
nonprivileged information
electronic media
6. The condition of being secluded from the presence or view of others.
Confidential communication
(ERISA) Employee Retirement Income Security Act of 1974
ee schedule
privacy
7. 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
Embezzlement
(ERISA) Employee Retirement Income Security Act of 1974
deductible
ids
8. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
cash flow
(UCR) Usual - Customary and Reasonable
consulting physician
9. 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)
transaction
Confidential communication
clearinghouse
Consent form
10. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
consent
Experimental Procedures
(PCN) Primary Care Network
complience
11. 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
(Non-par) Non-Participating Provider
covered entity
(DOS) Date of Service
(PEC) Pre-existing condition
12. Medical staff member who is legally responsible for the care and treatment given to a patient.
(POS) Point-of Service Plan
(UR) Utilization review
ethics
attending physician
13. Verbal or written agreement that gives approval to some action - situation - or statement.
(DCI) Duplicate Coverage Inquiry
(DRG's)
consent
(UR) Utilization review
14. A structure for classifying outpatient services and procedures for purpose of payment
crossover claim
Coordinated Coverage
claim
(APC) Ambulatory Patient Classifications
15. 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
referral
(COBRA)
state preemption
16. 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
Supplementary Medical Insurance
(AOB) Assignment of Benefits
confidentiality
privacy
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
Protected health information
(EPO) Exclusive Provider Organization
abuse
Assignment & Authorization
18. A provision that apples when a person is covered under more than one group medical program
confidentiality
(COB) Coordination of Benefits
Experimental Procedures
Treating or performing physician
19. 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
(UCR) Usual - Customary and Reasonable
ordering physician
Subscriber
(PCP) Primary Care Physician
20. The amount of actual money available to the medical practice
Claim
cash flow
(APC) Ambulatory Patient Classifications
(AOB) Assignment of Benefits
21. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
ids
(DCI) Duplicate Coverage Inquiry
(Non-par) Non-Participating Provider
22. 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
closed panel HMO
Individually identifiable health information
Out of Network (OON)
premium
23. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Standard
(TPA) Third Party Administrator
Assignment & Authorization
Beneficiary
24. A nonprofit integrated delivery system
breach of confidential communication
Network
Deductible
medical foundation
25. 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
Sub-acute Care
pcp
fraud
26. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
referring physician
complience plan
(DOS) Date of Service
disclosure
27. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(UR) Utilization review
electronic media
Claim
ordering physician
28. 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 panel HMO
medical foundation
Open Enrollment
ids
29. 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.
subscriber
Notice of Privacy Practices
Participating Provider
(Non-par) Non-Participating Provider
30. Is the provider who renders a service to a patient
(UR) Utilization review
health care provider
Individually identifiable health information
Treating or performing physician
31. 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
Deductible
electronic media
preauthorization
32. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(PAC) Pre- Admission Certification
closed panel HMO
security officer
pcp
33. 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
(COB) Coordination of Benefits
Sub-acute Care
Maximum Out Of Pocket
34. 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
Deductible
pcp
Participating Provider
Coordinated Coverage
35. 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
(ABN) Advance Beneficiary Notice
Privacy officer
Subscriber
Participating Provider
36. Is the provider who renders a service to a patient
ppo
Treating or performing physician
econdary Payer
(ABN) Advance Beneficiary Notice
37. 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
(POS) Point-of Service Plan
authorization form
Coordinated Coverage
Security Rule
38. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
prepaid plan
Confidential communication
(PCP) Primary Care Physician
39. The dates of healthcare services were provided to the beneficiary
Sub-acute Care
(Non-par) Non-Participating Provider
consent
(DOS) Date of Service
40. 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
health care provider
HIPAA
Sub-acute Care
referring physician
41. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Medigap Insurance
(TPA) Third Party Administrator
security officer
Resonable Charge
42. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Covered Expenses
(PCP) Primary Care Physician
preauthorization
abuse
43. 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
(Non-par) Non-Participating Provider
Claim
Supplementary Medical Insurance
(POS) Point-of Service Plan
44. An intentional misrepresentation of the facts to deceive or mislead another.
(DME) Durable Medical Equipment
(COBRA)
(TPA) Third Party Administrator
fraud
45. 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
Consent form
Security Rule
(UCR) Usual - Customary and Reasonable
(DME) Durable Medical Equipment
46. The maximum amount a plan pays for a covered service
Allowed Expenses
confidentiality
(EPO) Exclusive Provider Organization
business associate
47. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
claim
(COB) Coordination of Benefits
Subscriber
Deductible
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.
(ABN) Advance Beneficiary Notice
state preemption
Covered Expenses
(PAC) Pre- Admission Certification
49. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
deductible
abuse
Coordinated Coverage
medical foundation
50. American Medical Association
(ERISA) Employee Retirement Income Security Act of 1974
AMA
(Non-par) Non-Participating Provider
Open Enrollment