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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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.
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 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
complience
authorization form
(DRG's)
(PAC) Pre- Admission Certification
2. The amount of actual money available to the medical practice
subscriber
cash flow
Security Rule
Supplementary Medical Insurance
3. 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.
Protected health information
Out of Network (OON)
covered entity
(PAC) Pre- Admission Certification
4. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
Sub-acute Care
Resonable Charge
referring physician
5. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
phantom billing
confidentiality
Network
ppo
6. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
complience
ordering physician
(DME) Durable Medical Equipment
Resonable Charge
7. The condition of being secluded from the presence or view of others.
self-referral
IIHI
consent
privacy
8. 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.
business associate
self-referral
Beneficiary
health care provider
9. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
Resonable Charge
Individually identifiable health information
(PCP) Primary Care Physician
10. 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
covered entity
state preemption
pos
transaction
11. An intentional misrepresentation of the facts to deceive or mislead another.
Security Rule
ethics
fraud
Standard
12. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Resonable Charge
Protected health information
security officer
hmo
13. Individually identifiable health information
Subscriber
health care provider
fraud
IIHI
14. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
(AOB) Assignment of Benefits
Specialist
ee schedule
15. A willful act by an employee of taking possession of an employer's money
transaction
pos
ethics
Embezzlement
16. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
medical foundation
consent
Notice of Privacy Practices
(UR) Utilization review
17. 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
ethics
pos
Participating Provider
consulting physician
18. A review of the need for inpatient hospital care - completed before the actual admission
(ERISA) Employee Retirement Income Security Act of 1974
(PCP) Primary Care Physician
health care provider
(PAC) Pre- Admission Certification
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
Experimental Procedures
ordering physician
Preauthorization
Confidential communication
20. 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
Supplementary Medical Insurance
Treating or performing physician
Sub-acute Care
claim
21. 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
(PAC) Pre- Admission Certification
Treating or performing physician
Embezzlement
open panel HMO
22. Someone who is eligible for or receiving benefits under an insurance policy or plan
abuse
Beneficiary
Pre-certification
medical foundation
23. A monthly fee paid by the insured for specific medical insurance coverage
medical foundation
premium
Privacy officer
nonprivileged information
24. The period of time that payment for Medicare inpatient hospital benefits are available
complience plan
self-referral
benefit period
Experimental Procedures
25. Medical services provided on an outpatient basis
ppo
Network
Supplementary Medical Insurance
Amblatory Care
26. Integrating benefits payable under more than one health insurance.
Embezzlement
claim
attending physician
Coordinated Coverage
27. The maximum amount a plan pays for a covered service
Allowed Expenses
(PPS) Hospital Impatient Prospective Payment System
nonprivileged information
(DOS) Date of Service
28. 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
(AOB) Assignment of Benefits
(EPO) Exclusive Provider Organization
Assignment & Authorization
29. A patient claim is eligible for medicare and medicaid
epo
Allowed Expenses
(PCP) Primary Care Physician
crossover claim
30. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
IIHI
(PCP) Primary Care Physician
privacy
31. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
subscriber
(PPS) Hospital Impatient Prospective Payment System
Pre-certification
Confidential communication
32. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
complience
Embezzlement
Medigap Insurance
AMA
33. A nonprofit integrated delivery system
consent
medical foundation
(DRG's)
Pre-certification
34. An organization of provider sites with a contracted relationship that offer services
ids
(OOPs) Out of Pocket Costs/Expenses
crossover claim
Pre-certification
35. 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
Individually identifiable health information
Participating Provider
claim
36. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
ordering physician
Pre-existing Condition Exclusion
abuse
(TPA) Third Party Administrator
37. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
Pre-certification
(EPO) Exclusive Provider Organization
ethics
38. 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
(UCR) Usual - Customary and Reasonable
Claim
crossover claim
nonprivileged information
39. 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
(ERISA) Employee Retirement Income Security Act of 1974
Deductible
Beneficiary
(EPO) Exclusive Provider Organization
40. 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
prepaid plan
Notice of Privacy Practices
(COB) Coordination of Benefits
Embezzlement
41. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Maximum Out Of Pocket
Referral
Supplementary Medical Insurance
open panel HMO
42. Unauthorized release of information
breach of confidential communication
closed panel HMO
Coordinated Coverage
(EPO) Exclusive Provider Organization
43. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
Amblatory Care
security officer
benefit period
44. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Treating or performing physician
Individually identifiable health information
fraud
econdary Payer
45. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
complience
Referral
(DCI) Duplicate Coverage Inquiry
Sub-acute Care
46. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
breach of confidential communication
Deductible
pos
47. 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
transaction
(UCR) Usual - Customary and Reasonable
covered entity
confidentiality
48. 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
(PPS) Hospital Impatient Prospective Payment System
pcp
(ABN) Advance Beneficiary Notice
(AOB) Assignment of Benefits
49. 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
medical foundation
(UR) Utilization review
(ABN) Advance Beneficiary Notice
(COB) Coordination of Benefits
50. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
open panel HMO
consulting physician
Beneficiary
complience