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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 fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Notice of Privacy Practices
Resonable Charge
claim
Privacy officer
2. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Amblatory Care
pos
electronic media
3. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
HIPAA
Medigap Insurance
Claim
(PCP) Primary Care Physician
4. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
state preemption
(COB) Coordination of Benefits
(PCP) Primary Care Physician
5. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
econdary Payer
Experimental Procedures
Confidential communication
6. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Pre-existing Condition Exclusion
(PCP) Primary Care Physician
(Non-par) Non-Participating Provider
7. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Maximum Out Of Pocket
open panel HMO
Open Enrollment
Pre-certification
8. 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.
transaction
(UR) Utilization review
health care provider
medical foundation
9. Health Information Portability and Accountability Act
HIPAA
Security Rule
Allowed Expenses
Network
10. Individually identifiable health information
IIHI
(COB) Coordination of Benefits
open panel HMO
Referral
11. Is a provider who sends the patients for testing or treatment
referring physician
business associate
(UCR) Usual - Customary and Reasonable
self-referral
12. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
preauthorization
complience plan
Pre-certification
e-health information management
13. A structure for classifying outpatient services and procedures for purpose of payment
pos
(APC) Ambulatory Patient Classifications
claim
Protected health information
14. Integrating benefits payable under more than one health insurance.
(APC) Ambulatory Patient Classifications
referring physician
Coordinated Coverage
security officer
15. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
Supplementary Medical Insurance
(UCR) Usual - Customary and Reasonable
(COBRA)
Referral
16. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
fraud
clearinghouse
Subscriber
Consent form
17. 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
consent
Specialist
Maximum Out Of Pocket
ethics
18. Verbal or written agreement that gives approval to some action - situation - or statement.
epo
consent
epo
Coordinated Coverage
19. Medicare's method of paying acute care hospitals for inpatient care
ids
(EPO) Exclusive Provider Organization
(PPS) Hospital Impatient Prospective Payment System
transaction
20. A person who protects the computer and networking systems within the practice and implements protocols such as password assignment - backup procedures - firewalls - virus protection - and contingency planning for emergencies.
Amblatory Care
Sub-acute Care
security officer
prepaid plan
21. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
breach of confidential communication
self-referral
Claim
Coordinated Coverage
22. 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
premium
Open Enrollment
Allowed Expenses
crossover claim
23. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
cash flow
Confidential communication
disclosure
Privileged information
24. 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.
electronic media
Amblatory Care
Preauthorization
Protected health information
25. 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
Consent form
(UR) Utilization review
clearinghouse
Preauthorization
26. A list of the amount to be paid by an insurance company for each procedure service
etiquette
Privacy officer
Treating or performing physician
ee schedule
27. A nonprofit integrated delivery system
privacy
econdary Payer
medical foundation
premium
28. A provision that apples when a person is covered under more than one group medical program
(PPS) Hospital Impatient Prospective Payment System
health care provider
ppo
(COB) Coordination of Benefits
29. 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
Standard
Covered Expenses
claim
Security Rule
30. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
Medigap Insurance
Subscriber
fraud
31. The dates of healthcare services were provided to the beneficiary
referring physician
(DOS) Date of Service
Deductible
Sub-acute Care
32. A privileged communication that may be disclosed only with the patient's permission.
(PCP) Primary Care Physician
Confidential communication
premium
Participating Provider
33. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
etiquette
(COB) Coordination of Benefits
(OOPs) Out of Pocket Costs/Expenses
complience plan
34. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Security Rule
Treating or performing physician
Medigap Insurance
(ERISA) Employee Retirement Income Security Act of 1974
35. 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.
(PPS) Hospital Impatient Prospective Payment System
Deductible
Privileged information
AMA
36. 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
business associate
confidentiality
authorization form
epo
37. 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
privacy
referring physician
(DME) Durable Medical Equipment
fraud
38. 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.
referring physician
Supplementary Medical Insurance
Privileged information
complience plan
39. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Experimental Procedures
ordering physician
pcp
Preauthorization
40. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
complience
Specialist
(PPS) Hospital Impatient Prospective Payment System
(TPA) Third Party Administrator
41. 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
Claim
Consent form
covered entity
Preauthorization
42. Billing for services not performed
ppo
breach of confidential communication
phantom billing
HIPAA
43. American Medical Association
deductible
business associate
Beneficiary
AMA
44. 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
Specialist
Standard
phantom billing
45. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Pre-existing Condition Exclusion
(AOB) Assignment of Benefits
(PAC) Pre- Admission Certification
consulting physician
46. The condition of being secluded from the presence or view of others.
IIHI
(PCP) Primary Care Physician
privacy
consulting physician
47. 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
ordering physician
Covered Expenses
complience
nonprivileged information
48. 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
open panel HMO
clearinghouse
(AOB) Assignment of Benefits
(UR) Utilization review
49. 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
Standard
premium
Security Rule
Participating Provider
50. 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
phantom billing
(DME) Durable Medical Equipment
Medigap Insurance
Subscriber