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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
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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. 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
ppo
Out of Network (OON)
Beneficiary
(Non-par) Non-Participating Provider
2. A list of the amount to be paid by an insurance company for each procedure service
prepaid plan
security officer
ee schedule
Embezzlement
3. 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.
abuse
(DCI) Duplicate Coverage Inquiry
complience plan
Privacy officer
4. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
breach of confidential communication
medical foundation
electronic media
Embezzlement
5. 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
Security Rule
complience
privacy
prepaid plan
6. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
referral
(DRG's)
(UR) Utilization review
(DCI) Duplicate Coverage Inquiry
7. 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
AMA
Sub-acute Care
Treating or performing physician
Coordinated Coverage
8. 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
closed panel HMO
(Non-par) Non-Participating Provider
(COB) Coordination of Benefits
Supplementary Medical Insurance
9. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
ee schedule
claim
Security Rule
(PPS) Hospital Impatient Prospective Payment System
10. 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)
pcp
abuse
Consent form
security officer
11. 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
IIHI
crossover claim
(ERISA) Employee Retirement Income Security Act of 1974
(COBRA)
12. 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.
Privileged information
complience
Beneficiary
ppo
13. A review of the need for inpatient hospital care - completed before the actual admission
medical foundation
(PAC) Pre- Admission Certification
Specialist
(COB) Coordination of Benefits
14. Unauthorized release of information
Assignment & Authorization
breach of confidential communication
privacy
referral
15. A willful act by an employee of taking possession of an employer's money
Embezzlement
closed panel HMO
state preemption
covered entity
16. Is a provider who sends the patients for testing or treatment
(AOB) Assignment of Benefits
security officer
Privacy officer
referring physician
17. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
covered entity
(DOS) Date of Service
authorization form
18. Customs - rules of conduct - courtesy - and manners of the medical profession
(PEC) Pre-existing condition
ids
premium
etiquette
19. A review of the need for inpatient hospital care - completed before the actual admission
(POS) Point-of Service Plan
referring physician
premium
(PAC) Pre- Admission Certification
20. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
nonprivileged information
Sub-acute Care
Pre-certification
Resonable Charge
21. 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.
ppo
Notice of Privacy Practices
Experimental Procedures
(PPS) Hospital Impatient Prospective Payment System
22. American Medical Association
Deductible
AMA
(PEC) Pre-existing condition
(DME) Durable Medical Equipment
23. 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
(DME) Durable Medical Equipment
nonprivileged information
etiquette
Security Rule
24. 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.
complience plan
(TPA) Third Party Administrator
business associate
Privileged information
25. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
hmo
security officer
electronic media
26. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
e-health information management
Network
transaction
Pre-certification
27. Someone who is eligible for or receiving benefits under an insurance policy or plan
Participating Provider
Beneficiary
Deductible
Participating Provider
28. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Beneficiary
(COB) Coordination of Benefits
(ERISA) Employee Retirement Income Security Act of 1974
29. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
consulting physician
(PCN) Primary Care Network
Specialist
referral
30. 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
(AOB) Assignment of Benefits
Deductible
complience
Pre-existing Condition Exclusion
31. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
Sub-acute Care
premium
complience
32. 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
(AOB) Assignment of Benefits
(UR) Utilization review
security officer
Consent form
33. A nonprofit integrated delivery system
(PPS) Hospital Impatient Prospective Payment System
AMA
Privileged information
medical foundation
34. Billing for services not performed
IIHI
Open Enrollment
(TPA) Third Party Administrator
phantom billing
35. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
(PCN) Primary Care Network
Network
Specialist
Out of Network (OON)
36. 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.
Amblatory Care
premium
Protected health information
fraud
37. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
state preemption
(Non-par) Non-Participating Provider
abuse
cash flow
38. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Security Rule
consulting physician
(EPO) Exclusive Provider Organization
Pre-certification
39. 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
Open Enrollment
privacy
deductible
40. 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.
health care provider
(COBRA)
consent
(UR) Utilization review
41. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Out of Network (OON)
transaction
Coordinated Coverage
benefit period
42. 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
HIPAA
fraud
Out of Network (OON)
disclosure
43. 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
disclosure
(UCR) Usual - Customary and Reasonable
nonprivileged information
Assignment & Authorization
44. A willful act by an employee of taking possession of an employer's money
Embezzlement
Covered Expenses
abuse
etiquette
45. Individually identifiable health information
Security Rule
Consent form
IIHI
Treating or performing physician
46. Standards of conduct generally accepted as a moral guide for behavior.
ethics
Amblatory Care
abuse
disclosure
47. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Preauthorization
complience
Privileged information
phantom billing
48. 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
Security Rule
(POS) Point-of Service Plan
Pre-existing Condition Exclusion
HIPAA
49. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
(DRG's)
ids
Experimental Procedures
50. 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
ppo
Participating Provider
econdary Payer
health care provider