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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 privileged communication that may be disclosed only with the patient's permission.
Out of Network (OON)
Amblatory Care
Notice of Privacy Practices
Confidential communication
2. Medical staff member who is legally responsible for the care and treatment given to a patient.
medical foundation
Supplementary Medical Insurance
Assignment & Authorization
attending physician
3. A clinic that is owned by the HMO and the physicians are employees of the HMO
abuse
closed panel HMO
Pre-existing Condition Exclusion
state preemption
4. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
pos
(ERISA) Employee Retirement Income Security Act of 1974
hmo
(TPA) Third Party Administrator
5. 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
Confidential communication
(Non-par) Non-Participating Provider
Coordinated Coverage
Referral
6. 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.
benefit period
business associate
open panel HMO
Medigap Insurance
7. 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
(Non-par) Non-Participating Provider
epo
authorization form
referring physician
8. 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
consent
Specialist
Notice of Privacy Practices
Out of Network (OON)
9. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
(TPA) Third Party Administrator
prepaid plan
security officer
10. Standards of conduct generally accepted as a moral guide for behavior.
Treating or performing physician
Participating Provider
HIPAA
ethics
11. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(DRG's)
medical foundation
ppo
Subscriber
12. 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
state preemption
Subscriber
(DCI) Duplicate Coverage Inquiry
Preauthorization
13. What the insurance company will consider paying for as defined in the contract.
ee schedule
medical foundation
(PEC) Pre-existing condition
Covered Expenses
14. 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
Assignment & Authorization
Individually identifiable health information
Experimental Procedures
(DME) Durable Medical Equipment
15. 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.
transaction
Privileged information
Referral
(PPS) Hospital Impatient Prospective Payment System
16. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
Resonable Charge
Out of Network (OON)
Network
17. 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
covered entity
abuse
(PCN) Primary Care Network
18. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Preauthorization
crossover claim
deductible
referral
19. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Standard
Sub-acute Care
Claim
Treating or performing physician
20. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity
(ABN) Advance Beneficiary Notice
consulting physician
consent
Privacy officer
21. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
cash flow
Deductible
(DRG's)
Embezzlement
22. 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
HIPAA
cash flow
pcp
23. 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
state preemption
pcp
Pre-existing Condition Exclusion
ids
24. 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
Medigap Insurance
health care provider
security officer
prepaid plan
25. 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
consulting physician
prepaid plan
preauthorization
open panel HMO
26. A patient claim is eligible for medicare and medicaid
crossover claim
(PCP) Primary Care Physician
HIPAA
Pre-existing Condition Exclusion
27. A structure for classifying outpatient services and procedures for purpose of payment
medical foundation
breach of confidential communication
(APC) Ambulatory Patient Classifications
ethics
28. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
open panel HMO
ppo
Security Rule
Individually identifiable health information
29. 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
abuse
security officer
authorization form
breach of confidential communication
30. A list of the amount to be paid by an insurance company for each procedure service
health care provider
electronic media
crossover claim
ee schedule
31. The transmission of information between two parties to carry out financial or administrative activities related to health care.
hmo
Specialist
transaction
(PPS) Hospital Impatient Prospective Payment System
32. Is the provider who renders a service to a patient
Specialist
Treating or performing physician
Participating Provider
complience plan
33. What the insurance company will consider paying for as defined in the contract.
consent
medical foundation
Covered Expenses
econdary Payer
34. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
attending physician
pos
complience plan
referral
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
Participating Provider
Network
privacy
Consent form
36. 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
Coordinated Coverage
prepaid plan
Assignment & Authorization
Confidential communication
37. The period of time that payment for Medicare inpatient hospital benefits are available
(DCI) Duplicate Coverage Inquiry
Resonable Charge
clearinghouse
benefit period
38. 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
(PEC) Pre-existing condition
authorization form
Privacy officer
(AOB) Assignment of Benefits
39. A provision that apples when a person is covered under more than one group medical program
confidentiality
(COB) Coordination of Benefits
privacy
Embezzlement
40. 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.
Covered Expenses
(PCP) Primary Care Physician
state preemption
cash flow
41. Customs - rules of conduct - courtesy - and manners of the medical profession
phantom billing
(PAC) Pre- Admission Certification
etiquette
Beneficiary
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
subscriber
open panel HMO
closed panel HMO
(UCR) Usual - Customary and Reasonable
43. 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
Out of Network (OON)
(POS) Point-of Service Plan
IIHI
(PCN) Primary Care Network
44. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
privacy
Amblatory Care
Individually identifiable health information
45. 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
(ABN) Advance Beneficiary Notice
Referral
state preemption
46. 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
Treating or performing physician
fraud
breach of confidential communication
econdary Payer
47. An organization of provider sites with a contracted relationship that offer services
disclosure
ids
(PPS) Hospital Impatient Prospective Payment System
ee schedule
48. 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.
state preemption
(OOPs) Out of Pocket Costs/Expenses
Supplementary Medical Insurance
Notice of Privacy Practices
49. Health Information Portability and Accountability Act
HIPAA
Privacy officer
Specialist
security officer
50. A health insurance enrollee chooses to see an out of network provider without authorization
Referral
Privacy officer
referral
self-referral