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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 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
health care provider
consulting physician
(EPO) Exclusive Provider Organization
Maximum Out Of Pocket
2. 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
Subscriber
(DME) Durable Medical Equipment
prepaid plan
covered entity
3. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
hmo
Beneficiary
ordering physician
4. 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
(PCP) Primary Care Physician
Consent form
ppo
e-health information management
5. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(PEC) Pre-existing condition
benefit period
premium
(DCI) Duplicate Coverage Inquiry
6. A patient claim is eligible for medicare and medicaid
crossover claim
transaction
Notice of Privacy Practices
Privileged information
7. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
preauthorization
referring physician
Beneficiary
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
attending physician
Sub-acute Care
e-health information management
(Non-par) Non-Participating Provider
9. A rule - condition - or requirement
complience
preauthorization
Subscriber
Standard
10. 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
authorization form
nonprivileged information
etiquette
(POS) Point-of Service Plan
11. 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
disclosure
(PCP) Primary Care Physician
privacy
ethics
12. 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
Participating Provider
electronic media
Assignment & Authorization
Treating or performing physician
13. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Assignment & Authorization
deductible
Referral
14. 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.
privacy
Specialist
state preemption
(PEC) Pre-existing condition
15. 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.
(PEC) Pre-existing condition
business associate
Pre-existing Condition Exclusion
(PCN) Primary Care Network
16. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
health care provider
(COB) Coordination of Benefits
Claim
17. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Medigap Insurance
Referral
subscriber
Claim
18. 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.
state preemption
open panel HMO
consent
(DRG's)
19. A willful act by an employee of taking possession of an employer's money
(POS) Point-of Service Plan
(DCI) Duplicate Coverage Inquiry
Embezzlement
AMA
20. Is a provider who sends the patients for testing or treatment
Confidential communication
referring physician
abuse
(COB) Coordination of Benefits
21. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
complience
Assignment & Authorization
(PEC) Pre-existing condition
Resonable Charge
22. A managed care system that allows the patient to only select from a defined panel of providers - who are reimbursed on a modified fee-for-service method
(TPA) Third Party Administrator
Treating or performing physician
complience plan
epo
23. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
deductible
complience
Claim
(TPA) Third Party Administrator
24. 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)
(PAC) Pre- Admission Certification
complience
Allowed Expenses
Consent form
25. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
ee schedule
(UCR) Usual - Customary and Reasonable
consent
complience plan
26. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
Network
prepaid plan
pcp
27. Is a provider who sends the patients for testing or treatment
(PEC) Pre-existing condition
referring physician
Pre-certification
consulting physician
28. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
(PPS) Hospital Impatient Prospective Payment System
prepaid plan
Security Rule
29. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
Privileged information
IIHI
(ERISA) Employee Retirement Income Security Act of 1974
30. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
consulting physician
(UR) Utilization review
transaction
deductible
31. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
Coordinated Coverage
Individually identifiable health information
disclosure
(EPO) Exclusive Provider Organization
32. A structure for classifying outpatient services and procedures for purpose of payment
Experimental Procedures
(APC) Ambulatory Patient Classifications
(TPA) Third Party Administrator
Referral
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
Deductible
Referral
covered entity
(ERISA) Employee Retirement Income Security Act of 1974
34. 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
Referral
Pre-existing Condition Exclusion
premium
epo
35. Standards of conduct generally accepted as a moral guide for behavior.
clearinghouse
ethics
attending physician
Coordinated Coverage
36. 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
Beneficiary
open panel HMO
Protected health information
37. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
fraud
pcp
(PCN) Primary Care Network
security officer
38. Medical services provided on an outpatient basis
disclosure
privacy
Amblatory Care
Open Enrollment
39. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Experimental Procedures
subscriber
(OOPs) Out of Pocket Costs/Expenses
(EPO) Exclusive Provider Organization
40. A nonprofit integrated delivery system
(AOB) Assignment of Benefits
Standard
Individually identifiable health information
medical foundation
41. A list of the amount to be paid by an insurance company for each procedure service
Standard
ee schedule
HIPAA
Experimental Procedures
42. 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
Beneficiary
Assignment & Authorization
Experimental Procedures
(ABN) Advance Beneficiary Notice
43. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
ids
Sub-acute Care
Subscriber
abuse
44. 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
benefit period
(PEC) Pre-existing condition
Beneficiary
45. Integrating benefits payable under more than one health insurance.
Allowed Expenses
Coordinated Coverage
electronic media
Participating Provider
46. Standards of conduct generally accepted as a moral guide for behavior.
ethics
(PCP) Primary Care Physician
(UR) Utilization review
Maximum Out Of Pocket
47. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
HIPAA
Maximum Out Of Pocket
(PCN) Primary Care Network
48. 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
clearinghouse
Experimental Procedures
covered entity
IIHI
49. The period of time that payment for Medicare inpatient hospital benefits are available
pcp
ethics
benefit period
Embezzlement
50. A privileged communication that may be disclosed only with the patient's permission.
(APC) Ambulatory Patient Classifications
Confidential communication
Experimental Procedures
hmo