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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. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
self-referral
Subscriber
(DRG's)
Covered Expenses
2. 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
Privileged information
(PCP) Primary Care Physician
ee schedule
(UCR) Usual - Customary and Reasonable
3. 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
nonprivileged information
Open Enrollment
(PEC) Pre-existing condition
Supplementary Medical Insurance
4. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(TPA) Third Party Administrator
(PPS) Hospital Impatient Prospective Payment System
Claim
authorization form
5. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
transaction
Privacy officer
Confidential communication
referral
6. 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
abuse
(DME) Durable Medical Equipment
(PCN) Primary Care Network
state preemption
7. A rule - condition - or requirement
Coordinated Coverage
fraud
Embezzlement
Standard
8. 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
Preauthorization
Supplementary Medical Insurance
Sub-acute Care
self-referral
9. 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
(TPA) Third Party Administrator
subscriber
deductible
covered entity
10. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
(POS) Point-of Service Plan
(PCP) Primary Care Physician
Covered Expenses
11. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
ee schedule
nonprivileged information
complience
12. Billing for services not performed
covered entity
(OOPs) Out of Pocket Costs/Expenses
Amblatory Care
phantom billing
13. An intentional misrepresentation of the facts to deceive or mislead another.
covered entity
fraud
(ABN) Advance Beneficiary Notice
Individually identifiable health information
14. 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
nonprivileged information
e-health information management
Participating Provider
(DOS) Date of Service
15. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
referring physician
(Non-par) Non-Participating Provider
(PCN) Primary Care Network
16. 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
ee schedule
preauthorization
nonprivileged information
Open Enrollment
17. 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
consulting physician
(UCR) Usual - Customary and Reasonable
crossover claim
Pre-existing Condition Exclusion
18. Verbal or written agreement that gives approval to some action - situation - or statement.
health care provider
HIPAA
Referral
consent
19. 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
Coordinated Coverage
deductible
benefit period
Preauthorization
20. A nonprofit integrated delivery system
closed panel HMO
Consent form
medical foundation
health care provider
21. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Referral
ordering physician
Open Enrollment
attending physician
22. 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
pos
Participating Provider
(ABN) Advance Beneficiary Notice
ids
23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
closed panel HMO
(COBRA)
consent
Specialist
24. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
hmo
Notice of Privacy Practices
(OOPs) Out of Pocket Costs/Expenses
preauthorization
25. Health Information Portability and Accountability Act
(PPS) Hospital Impatient Prospective Payment System
HIPAA
(PEC) Pre-existing condition
abuse
26. 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
(COB) Coordination of Benefits
electronic media
(Non-par) Non-Participating Provider
econdary Payer
27. Medicare's method of paying acute care hospitals for inpatient care
ee schedule
(DME) Durable Medical Equipment
Deductible
(PPS) Hospital Impatient Prospective Payment System
28. A health insurance enrollee chooses to see an out of network provider without authorization
ppo
attending physician
Standard
self-referral
29. 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
confidentiality
phantom billing
prepaid plan
transaction
30. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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31. 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
Amblatory Care
Claim
ee schedule
Open Enrollment
32. 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
(DCI) Duplicate Coverage Inquiry
cash flow
(ABN) Advance Beneficiary Notice
Standard
33. 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
benefit period
Beneficiary
Confidential communication
(ERISA) Employee Retirement Income Security Act of 1974
34. 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
pos
(PEC) Pre-existing condition
pcp
35. Standards of conduct generally accepted as a moral guide for behavior.
Specialist
state preemption
security officer
ethics
36. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
prepaid plan
(APC) Ambulatory Patient Classifications
Experimental Procedures
Coordinated Coverage
37. Medical staff member who is legally responsible for the care and treatment given to a patient.
Coordinated Coverage
attending physician
Specialist
(PPS) Hospital Impatient Prospective Payment System
38. Unauthorized release of information
Claim
complience
breach of confidential communication
(DOS) Date of Service
39. 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
Notice of Privacy Practices
(PPS) Hospital Impatient Prospective Payment System
(PPS) Hospital Impatient Prospective Payment System
authorization form
40. Is the provider who renders a service to a patient
Subscriber
Notice of Privacy Practices
Specialist
Treating or performing physician
41. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(ERISA) Employee Retirement Income Security Act of 1974
Embezzlement
open panel HMO
42. 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)
e-health information management
Consent form
epo
Standard
43. American Medical Association
(DOS) Date of Service
AMA
epo
(OOPs) Out of Pocket Costs/Expenses
44. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
crossover claim
pos
(UCR) Usual - Customary and Reasonable
premium
45. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
closed panel HMO
Embezzlement
Medigap Insurance
46. Someone who is eligible for or receiving benefits under an insurance policy or plan
HIPAA
complience plan
Deductible
Beneficiary
47. 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.
Notice of Privacy Practices
cash flow
confidentiality
econdary Payer
48. A patient claim is eligible for medicare and medicaid
(DME) Durable Medical Equipment
(PEC) Pre-existing condition
ppo
crossover claim
49. 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
clearinghouse
Consent form
cash flow
pos
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
referring physician
(DME) Durable Medical Equipment
(DRG's)
Resonable Charge