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Test your basic knowledge |
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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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. A structure for classifying outpatient services and procedures for purpose of payment
Standard
(APC) Ambulatory Patient Classifications
authorization form
nonprivileged information
2. A privileged communication that may be disclosed only with the patient's permission.
(POS) Point-of Service Plan
Confidential communication
prepaid plan
fraud
3. 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
Coordinated Coverage
(Non-par) Non-Participating Provider
(PPS) Hospital Impatient Prospective Payment System
Treating or performing physician
4. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Pre-certification
medical foundation
(UCR) Usual - Customary and Reasonable
authorization form
5. 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
IIHI
(PAC) Pre- Admission Certification
complience plan
(PCN) Primary Care Network
6. A list of the amount to be paid by an insurance company for each procedure service
business associate
Sub-acute Care
econdary Payer
ee schedule
7. 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)
Consent form
phantom billing
(PCP) Primary Care Physician
crossover claim
8. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
subscriber
e-health information management
complience
Claim
9. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
premium
benefit period
Deductible
10. 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.
Consent form
(DME) Durable Medical Equipment
Treating or performing physician
Privacy officer
11. American Medical Association
complience plan
AMA
open panel HMO
(DRG's)
12. Medical staff member who is legally responsible for the care and treatment given to a patient.
benefit period
Experimental Procedures
attending physician
Maximum Out Of Pocket
13. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Confidential communication
(Non-par) Non-Participating Provider
ordering physician
closed panel HMO
14. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Specialist
ordering physician
Notice of Privacy Practices
Referral
15. 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.
deductible
Privacy officer
hmo
(DRG's)
16. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
business associate
(PCN) Primary Care Network
authorization form
17. American Medical Association
(PEC) Pre-existing condition
self-referral
AMA
Standard
18. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(DRG's)
Network
electronic media
Open Enrollment
19. A monthly fee paid by the insured for specific medical insurance coverage
premium
Subscriber
(UCR) Usual - Customary and Reasonable
Participating Provider
20. A patient claim is eligible for medicare and medicaid
(DRG's)
Experimental Procedures
(UCR) Usual - Customary and Reasonable
crossover claim
21. An organization of provider sites with a contracted relationship that offer services
prepaid plan
clearinghouse
ids
security officer
22. 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
closed panel HMO
Preauthorization
referring physician
ethics
23. 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
Network
Sub-acute Care
(PCP) Primary Care Physician
(DOS) Date of Service
24. 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
Participating Provider
referral
subscriber
disclosure
25. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
state preemption
clearinghouse
pcp
Allowed Expenses
26. The maximum amount a plan pays for a covered service
ppo
Allowed Expenses
self-referral
Pre-existing Condition Exclusion
27. Medicare's method of paying acute care hospitals for inpatient care
complience
state preemption
(PPS) Hospital Impatient Prospective Payment System
Standard
28. 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.
Protected health information
phantom billing
Notice of Privacy Practices
(ABN) Advance Beneficiary Notice
29. The amount of actual money available to the medical practice
Supplementary Medical Insurance
Notice of Privacy Practices
cash flow
Participating Provider
30. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Resonable Charge
(POS) Point-of Service Plan
(DRG's)
31. A willful act by an employee of taking possession of an employer's money
Embezzlement
Claim
Maximum Out Of Pocket
transaction
32. 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
Open Enrollment
(POS) Point-of Service Plan
premium
Confidential communication
33. 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
(EPO) Exclusive Provider Organization
breach of confidential communication
Experimental Procedures
Claim
34. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
confidentiality
(DCI) Duplicate Coverage Inquiry
(PAC) Pre- Admission Certification
ids
35. 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
(OOPs) Out of Pocket Costs/Expenses
econdary Payer
etiquette
36. 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
epo
crossover claim
Sub-acute Care
(COBRA)
37. 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
business associate
Pre-existing Condition Exclusion
open panel HMO
(PCP) Primary Care Physician
38. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
fraud
Resonable Charge
Confidential communication
Embezzlement
39. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
disclosure
Confidential communication
privacy
40. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(UR) Utilization review
(POS) Point-of Service Plan
complience
(DME) Durable Medical Equipment
41. Is a provider who sends the patients for testing or treatment
referring physician
Covered Expenses
hmo
Beneficiary
42. 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
(DRG's)
(PCP) Primary Care Physician
consulting physician
breach of confidential communication
43. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
open panel HMO
transaction
abuse
44. 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.
(DME) Durable Medical Equipment
pos
Assignment & Authorization
Notice of Privacy Practices
45. A provision that apples when a person is covered under more than one group medical program
consulting physician
attending physician
preauthorization
(COB) Coordination of Benefits
46. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
attending physician
Standard
(EPO) Exclusive Provider Organization
health care provider
47. 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
(Non-par) Non-Participating Provider
ids
authorization form
48. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
privacy
abuse
Security Rule
(OOPs) Out of Pocket Costs/Expenses
49. 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
(PAC) Pre- Admission Certification
Experimental Procedures
Out of Network (OON)
Assignment & Authorization
50. 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
closed panel HMO
(DRG's)
ppo
Pre-existing Condition Exclusion