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Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
deductible
Open Enrollment
pos
abuse
2. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
ppo
authorization form
Confidential communication
confidentiality
3. A patient claim is eligible for medicare and medicaid
Resonable Charge
referring physician
crossover claim
privacy
4. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Medigap Insurance
Beneficiary
epo
(UCR) Usual - Customary and Reasonable
5. The condition of being secluded from the presence or view of others.
electronic media
phantom billing
privacy
consent
6. 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
Supplementary Medical Insurance
(ERISA) Employee Retirement Income Security Act of 1974
(TPA) Third Party Administrator
Maximum Out Of Pocket
7. Medical services provided on an outpatient basis
Amblatory Care
Deductible
IIHI
Referral
8. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Referral
Confidential communication
business associate
Network
9. A nonprofit integrated delivery system
medical foundation
phantom billing
(DOS) Date of Service
cash flow
10. American Medical Association
ethics
AMA
Confidential communication
Embezzlement
11. 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
(PEC) Pre-existing condition
(DRG's)
Privileged information
12. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(DCI) Duplicate Coverage Inquiry
Resonable Charge
etiquette
disclosure
13. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
Beneficiary
hmo
Amblatory Care
14. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
nonprivileged information
privacy
hmo
(DRG's)
15. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(TPA) Third Party Administrator
abuse
etiquette
Notice of Privacy Practices
16. 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
(PCP) Primary Care Physician
(DOS) Date of Service
(POS) Point-of Service Plan
subscriber
17. Individually identifiable health information
claim
disclosure
IIHI
privacy
18. 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.
pos
health care provider
Amblatory Care
complience
19. 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
Confidential communication
fraud
(ABN) Advance Beneficiary Notice
open panel HMO
20. American Medical Association
AMA
Standard
e-health information management
referring physician
21. Health Information Portability and Accountability Act
Confidential communication
HIPAA
clearinghouse
Subscriber
22. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
security officer
nonprivileged information
Specialist
Pre-existing Condition Exclusion
23. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
ordering physician
(PAC) Pre- Admission Certification
nonprivileged information
24. An organization of provider sites with a contracted relationship that offer services
Standard
ids
(ERISA) Employee Retirement Income Security Act of 1974
ethics
25. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(EPO) Exclusive Provider Organization
(COBRA)
Out of Network (OON)
ordering physician
26. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
(COB) Coordination of Benefits
(UR) Utilization review
Participating Provider
27. Standards of conduct generally accepted as a moral guide for behavior.
transaction
ethics
(PCP) Primary Care Physician
fraud
28. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
breach of confidential communication
(PEC) Pre-existing condition
state preemption
closed panel HMO
29. 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
Preauthorization
(TPA) Third Party Administrator
Sub-acute Care
Treating or performing physician
30. Medical services provided on an outpatient basis
self-referral
(DOS) Date of Service
Amblatory Care
disclosure
31. Customs - rules of conduct - courtesy - and manners of the medical profession
Pre-existing Condition Exclusion
etiquette
Specialist
Amblatory Care
32. 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.
ids
security officer
privacy
closed panel HMO
33. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
(DME) Durable Medical Equipment
epo
(UCR) Usual - Customary and Reasonable
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
Pre-certification
(DOS) Date of Service
Specialist
Pre-existing Condition Exclusion
35. A structure for classifying outpatient services and procedures for purpose of payment
Specialist
Pre-certification
confidentiality
(APC) Ambulatory Patient Classifications
36. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
disclosure
abuse
(PAC) Pre- Admission Certification
Individually identifiable health information
37. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
(PEC) Pre-existing condition
Supplementary Medical Insurance
Experimental Procedures
38. 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
(COB) Coordination of Benefits
transaction
(PCN) Primary Care Network
Coordinated Coverage
39. 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.
consulting physician
(DCI) Duplicate Coverage Inquiry
Notice of Privacy Practices
breach of confidential communication
40. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
(DOS) Date of Service
claim
(DRG's)
41. A clinic that is owned by the HMO and the physicians are employees of the HMO
(TPA) Third Party Administrator
Open Enrollment
closed panel HMO
HIPAA
42. Standards of conduct generally accepted as a moral guide for behavior.
ethics
consulting physician
deductible
referring physician
43. 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
Preauthorization
premium
complience
epo
44. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Amblatory Care
Standard
disclosure
(OOPs) Out of Pocket Costs/Expenses
45. 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
consulting physician
Assignment & Authorization
Protected health information
(OOPs) Out of Pocket Costs/Expenses
46. 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.
Network
Embezzlement
Privacy officer
(DRG's)
47. 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
Maximum Out Of Pocket
(PPS) Hospital Impatient Prospective Payment System
Maximum Out Of Pocket
Sub-acute Care
48. 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
IIHI
nonprivileged information
Standard
Preauthorization
49. A review of the need for inpatient hospital care - completed before the actual admission
Specialist
Protected health information
(PAC) Pre- Admission Certification
pos
50. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Confidential communication
transaction
(APC) Ambulatory Patient Classifications
(ABN) Advance Beneficiary Notice
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