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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. A monthly fee paid by the insured for specific medical insurance coverage
(OOPs) Out of Pocket Costs/Expenses
(PPS) Hospital Impatient Prospective Payment System
Assignment & Authorization
premium
2. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
(EPO) Exclusive Provider Organization
referring physician
(PPS) Hospital Impatient Prospective Payment System
3. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
HIPAA
Open Enrollment
(DCI) Duplicate Coverage Inquiry
consulting physician
4. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Claim
Privacy officer
Network
(UCR) Usual - Customary and Reasonable
5. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment
premium
(DME) Durable Medical Equipment
(DCI) Duplicate Coverage Inquiry
(PCP) Primary Care Physician
6. 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
Security Rule
Referral
ee schedule
7. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
consulting physician
closed panel HMO
Resonable Charge
(PPS) Hospital Impatient Prospective Payment System
8. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Confidential communication
referring physician
referral
Standard
9. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
business associate
pcp
Covered Expenses
10. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Consent form
benefit period
(PPS) Hospital Impatient Prospective Payment System
subscriber
11. A patient claim is eligible for medicare and medicaid
confidentiality
crossover claim
(PCN) Primary Care Network
covered entity
12. A nonprofit integrated delivery system
(PCP) Primary Care Physician
clearinghouse
medical foundation
Supplementary Medical Insurance
13. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Consent form
security officer
Referral
attending physician
14. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Referral
premium
disclosure
Individually identifiable health information
15. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Supplementary Medical Insurance
security officer
Privacy officer
16. 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
state preemption
(AOB) Assignment of Benefits
Claim
17. What the insurance company will consider paying for as defined in the contract.
(TPA) Third Party Administrator
Covered Expenses
hmo
pcp
18. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
privacy
hmo
complience
(PPS) Hospital Impatient Prospective Payment System
19. 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
ordering physician
(ABN) Advance Beneficiary Notice
nonprivileged information
Notice of Privacy Practices
20. The dates of healthcare services were provided to the beneficiary
hmo
(APC) Ambulatory Patient Classifications
e-health information management
(DOS) Date of Service
21. Billing for services not performed
Individually identifiable health information
phantom billing
Participating Provider
authorization form
22. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
clearinghouse
business associate
(UR) Utilization review
23. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Referral
(APC) Ambulatory Patient Classifications
(COBRA)
24. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
Allowed Expenses
IIHI
(POS) Point-of Service Plan
25. 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.
Specialist
Participating Provider
health care provider
(TPA) Third Party Administrator
26. 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.
Pre-certification
(TPA) Third Party Administrator
(PCN) Primary Care Network
Privileged information
27. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
self-referral
subscriber
pos
Pre-existing Condition Exclusion
28. 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
nonprivileged information
ee schedule
(Non-par) Non-Participating Provider
Network
29. Standards of conduct generally accepted as a moral guide for behavior.
Individually identifiable health information
Participating Provider
ethics
security officer
30. 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-existing Condition Exclusion
consent
(Non-par) Non-Participating Provider
(ERISA) Employee Retirement Income Security Act of 1974
31. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
(UCR) Usual - Customary and Reasonable
(DOS) Date of Service
crossover claim
pos
32. Health Information Portability and Accountability Act
covered entity
HIPAA
Security Rule
Pre-certification
33. 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
disclosure
HIPAA
Open Enrollment
Beneficiary
34. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
Consent form
Individually identifiable health information
(COB) Coordination of Benefits
35. Medical staff member who is legally responsible for the care and treatment given to a patient.
Consent form
attending physician
referral
(AOB) Assignment of Benefits
36. 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
(OOPs) Out of Pocket Costs/Expenses
Coordinated Coverage
Experimental Procedures
open panel HMO
37. 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
(Non-par) Non-Participating Provider
(UR) Utilization review
(DCI) Duplicate Coverage Inquiry
premium
38. 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
open panel HMO
business associate
ppo
Subscriber
39. 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
Out of Network (OON)
(DME) Durable Medical Equipment
Assignment & Authorization
40. 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
(ABN) Advance Beneficiary Notice
attending physician
Supplementary Medical Insurance
(ERISA) Employee Retirement Income Security Act of 1974
41. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
abuse
phantom billing
(POS) Point-of Service Plan
42. 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
econdary Payer
confidentiality
Allowed Expenses
pos
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
(ABN) Advance Beneficiary Notice
(POS) Point-of Service Plan
Assignment & Authorization
business associate
44. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
health care provider
e-health information management
ordering physician
phantom billing
45. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
business associate
consent
Individually identifiable health information
AMA
46. American Medical Association
(ERISA) Employee Retirement Income Security Act of 1974
Referral
AMA
(TPA) Third Party Administrator
47. Is the provider who renders a service to a patient
fraud
Treating or performing physician
pos
(COBRA)
48. Individually identifiable health information
referring physician
prepaid plan
(DCI) Duplicate Coverage Inquiry
IIHI
49. 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
Claim
Open Enrollment
complience plan
50. 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.
Specialist
referring physician
Notice of Privacy Practices
pos