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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.
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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 group of primary care physicians who have joined together to share the risk of providing care to their patients who are covered by a given health plan
(PPS) Hospital Impatient Prospective Payment System
Coordinated Coverage
(PCN) Primary Care Network
Notice of Privacy Practices
2. 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
(APC) Ambulatory Patient Classifications
benefit period
referral
3. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(PAC) Pre- Admission Certification
health care provider
(DME) Durable Medical Equipment
complience plan
4. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(PAC) Pre- Admission Certification
Individually identifiable health information
econdary Payer
ordering physician
5. 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
(EPO) Exclusive Provider Organization
ids
prepaid plan
consent
6. 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)
premium
Consent form
privacy
(PCP) Primary Care Physician
7. Health Information Portability and Accountability Act
disclosure
medical foundation
Participating Provider
HIPAA
8. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
clearinghouse
Security Rule
security officer
9. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Referral
consulting physician
clearinghouse
10. Unauthorized release of information
confidentiality
breach of confidential communication
(AOB) Assignment of Benefits
(DRG's)
11. 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
claim
AMA
business associate
Preauthorization
12. Customs - rules of conduct - courtesy - and manners of the medical profession
benefit period
breach of confidential communication
etiquette
disclosure
13. 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
premium
Security Rule
nonprivileged information
privacy
14. 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
(EPO) Exclusive Provider Organization
(POS) Point-of Service Plan
(UCR) Usual - Customary and Reasonable
state preemption
15. 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
Sub-acute Care
Open Enrollment
benefit period
transaction
16. The period of time that payment for Medicare inpatient hospital benefits are available
Notice of Privacy Practices
health care provider
benefit period
Preauthorization
17. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(TPA) Third Party Administrator
health care provider
self-referral
electronic media
18. An intentional misrepresentation of the facts to deceive or mislead another.
ppo
fraud
(PCP) Primary Care Physician
electronic media
19. Is the provider who renders a service to a patient
Treating or performing physician
(TPA) Third Party Administrator
Privacy officer
nonprivileged information
20. 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
e-health information management
Privileged information
(ERISA) Employee Retirement Income Security Act of 1974
Security Rule
21. The dates of healthcare services were provided to the beneficiary
security officer
Confidential communication
(DOS) Date of Service
transaction
22. An organization of provider sites with a contracted relationship that offer services
transaction
(PEC) Pre-existing condition
ids
authorization form
23. A privileged communication that may be disclosed only with the patient's permission.
pcp
self-referral
Maximum Out Of Pocket
Confidential communication
24. Verbal or written agreement that gives approval to some action - situation - or statement.
hmo
Privileged information
consent
Claim
25. 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
econdary Payer
claim
Referral
26. 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
consent
Pre-existing Condition Exclusion
authorization form
Beneficiary
27. 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.
(DCI) Duplicate Coverage Inquiry
Privacy officer
(PEC) Pre-existing condition
Embezzlement
28. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
medical foundation
clearinghouse
complience
Standard
29. 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
Supplementary Medical Insurance
open panel HMO
Individually identifiable health information
business associate
30. 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.
(PCN) Primary Care Network
transaction
health care provider
fraud
31. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(PPS) Hospital Impatient Prospective Payment System
Claim
pos
clearinghouse
32. 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
(DCI) Duplicate Coverage Inquiry
Medigap Insurance
pos
(ABN) Advance Beneficiary Notice
33. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Covered Expenses
business associate
Referral
self-referral
34. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
consulting physician
referring physician
AMA
35. 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
ethics
epo
Security Rule
36. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
consulting physician
referral
Supplementary Medical Insurance
Privileged information
37. 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
ee schedule
econdary Payer
Assignment & Authorization
(ERISA) Employee Retirement Income Security Act of 1974
38. 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.
Deductible
Supplementary Medical Insurance
state preemption
(DOS) Date of Service
39. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DRG's)
(Non-par) Non-Participating Provider
claim
Referral
40. 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
referring physician
phantom billing
Privileged information
Pre-existing Condition Exclusion
41. 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)
AMA
Maximum Out Of Pocket
crossover claim
42. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
covered entity
(PEC) Pre-existing condition
Protected health information
Individually identifiable health information
43. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(TPA) Third Party Administrator
referring physician
preauthorization
complience plan
44. The maximum amount a plan pays for a covered service
Allowed Expenses
Subscriber
complience plan
ethics
45. The dates of healthcare services were provided to the beneficiary
(TPA) Third Party Administrator
Amblatory Care
nonprivileged information
(DOS) Date of Service
46. 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
Deductible
epo
Pre-existing Condition Exclusion
(DRG's)
47. 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
(DRG's)
self-referral
transaction
covered entity
48. 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
ppo
Network
(DME) Durable Medical Equipment
privacy
49. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
privacy
abuse
Privileged information
preauthorization
50. A list of the amount to be paid by an insurance company for each procedure service
clearinghouse
referring physician
ee schedule
transaction