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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Amblatory Care
Referral
complience
Allowed Expenses
2. 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
Maximum Out Of Pocket
(DCI) Duplicate Coverage Inquiry
Pre-existing Condition Exclusion
Coordinated Coverage
3. 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
prepaid plan
ordering physician
etiquette
4. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
(APC) Ambulatory Patient Classifications
Pre-existing Condition Exclusion
covered entity
5. Verbal or written agreement that gives approval to some action - situation - or statement.
ethics
e-health information management
consent
(APC) Ambulatory Patient Classifications
6. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
Covered Expenses
(Non-par) Non-Participating Provider
claim
7. 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
Sub-acute Care
Open Enrollment
Maximum Out Of Pocket
nonprivileged information
8. 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.
(TPA) Third Party Administrator
Protected health information
crossover claim
ppo
9. 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
Privacy officer
(EPO) Exclusive Provider Organization
(PEC) Pre-existing condition
10. A structure for classifying outpatient services and procedures for purpose of payment
abuse
(APC) Ambulatory Patient Classifications
Individually identifiable health information
e-health information management
11. 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
(TPA) Third Party Administrator
(ABN) Advance Beneficiary Notice
e-health information management
12. 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
Pre-existing Condition Exclusion
econdary Payer
(TPA) Third Party Administrator
Maximum Out Of Pocket
13. American Medical Association
referring physician
AMA
Privacy officer
Standard
14. 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
Privacy officer
referral
open panel HMO
covered entity
15. 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
referring physician
e-health information management
privacy
16. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Standard
ethics
ppo
17. Unauthorized release of information
Protected health information
Privileged information
Preauthorization
breach of confidential communication
18. Is a provider who sends the patients for testing or treatment
cash flow
(POS) Point-of Service Plan
referring physician
closed panel HMO
19. A willful act by an employee of taking possession of an employer's money
Embezzlement
AMA
Out of Network (OON)
(AOB) Assignment of Benefits
20. 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.
Allowed Expenses
security officer
Notice of Privacy Practices
(POS) Point-of Service Plan
21. 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.
ids
Privacy officer
pcp
transaction
22. The condition of being secluded from the presence or view of others.
(PCN) Primary Care Network
complience plan
privacy
ppo
23. Standards of conduct generally accepted as a moral guide for behavior.
Maximum Out Of Pocket
disclosure
clearinghouse
ethics
24. 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
business associate
Maximum Out Of Pocket
Security Rule
25. 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
Security Rule
Notice of Privacy Practices
referral
26. Is the provider who renders a service to a patient
(APC) Ambulatory Patient Classifications
(COBRA)
Treating or performing physician
Amblatory Care
27. 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)
fraud
Coordinated Coverage
(PCP) Primary Care Physician
28. An intentional misrepresentation of the facts to deceive or mislead another.
referral
Privileged information
fraud
ids
29. Integrating benefits payable under more than one health insurance.
(UR) Utilization review
Coordinated Coverage
Maximum Out Of Pocket
premium
30. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
closed panel HMO
pcp
(AOB) Assignment of Benefits
Resonable Charge
31. An organization of provider sites with a contracted relationship that offer services
Specialist
IIHI
ids
prepaid plan
32. 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
ids
epo
(ERISA) Employee Retirement Income Security Act of 1974
33. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
AMA
referral
(UR) Utilization review
ids
34. The dates of healthcare services were provided to the beneficiary
consulting physician
(APC) Ambulatory Patient Classifications
(DOS) Date of Service
Specialist
35. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Claim
Pre-certification
Specialist
Network
36. 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.
HIPAA
ppo
Notice of Privacy Practices
(DME) Durable Medical Equipment
37. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Maximum Out Of Pocket
fraud
Out of Network (OON)
Network
38. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
pos
subscriber
consent
Resonable Charge
39. 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
(ABN) Advance Beneficiary Notice
medical foundation
open panel HMO
(PCN) Primary Care Network
40. American Medical Association
Notice of Privacy Practices
AMA
(UR) Utilization review
cash flow
41. 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
pcp
prepaid plan
(PEC) Pre-existing condition
Pre-certification
42. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Deductible
benefit period
(PEC) Pre-existing condition
(EPO) Exclusive Provider Organization
43. 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
epo
Out of Network (OON)
nonprivileged information
covered entity
44. 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
Participating Provider
benefit period
(Non-par) Non-Participating Provider
(AOB) Assignment of Benefits
45. 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
Referral
hmo
e-health information management
46. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(PEC) Pre-existing condition
(PCP) Primary Care Physician
pcp
Pre-existing Condition Exclusion
47. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
prepaid plan
(EPO) Exclusive Provider Organization
Notice of Privacy Practices
self-referral
48. What the insurance company will consider paying for as defined in the contract.
Supplementary Medical Insurance
epo
Covered Expenses
transaction
49. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
referring physician
Pre-existing Condition Exclusion
econdary Payer
Individually identifiable health information
50. 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
state preemption
complience
Specialist
Out of Network (OON)