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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. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
epo
(EPO) Exclusive Provider Organization
Individually identifiable health information
confidentiality
2. 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
subscriber
Preauthorization
Supplementary Medical Insurance
Security Rule
3. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Experimental Procedures
(TPA) Third Party Administrator
transaction
Confidential communication
4. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
Security Rule
business associate
Claim
referral
5. 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
Consent form
cash flow
covered entity
Open Enrollment
6. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Standard
subscriber
(DCI) Duplicate Coverage Inquiry
Consent form
7. The condition of being secluded from the presence or view of others.
Security Rule
Preauthorization
consent
privacy
8. A person - who on behalf of the covered entity - performs or assists in the performance of a function or activity involving the use or disclosure of individually identifieable health information.
state preemption
Beneficiary
business associate
IIHI
9. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(DOS) Date of Service
(EPO) Exclusive Provider Organization
phantom billing
Consent form
10. 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
phantom billing
consent
(COBRA)
Amblatory Care
11. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Privacy officer
Allowed Expenses
Resonable Charge
(UR) Utilization review
12. 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
clearinghouse
Security Rule
(UR) Utilization review
prepaid plan
13. Verbal or written agreement that gives approval to some action - situation - or statement.
complience
consent
(PCN) Primary Care Network
HIPAA
14. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
state preemption
(DOS) Date of Service
(EPO) Exclusive Provider Organization
(PCN) Primary Care Network
15. 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
deductible
claim
Individually identifiable health information
16. 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.
hmo
Experimental Procedures
Treating or performing physician
security officer
17. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Experimental Procedures
(COBRA)
(APC) Ambulatory Patient Classifications
18. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
deductible
Pre-existing Condition Exclusion
referring physician
19. A provision that apples when a person is covered under more than one group medical program
Assignment & Authorization
(COB) Coordination of Benefits
(DRG's)
security officer
20. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DME) Durable Medical Equipment
(EPO) Exclusive Provider Organization
Medigap Insurance
Subscriber
21. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(APC) Ambulatory Patient Classifications
etiquette
Deductible
hmo
22. A structure for classifying outpatient services and procedures for purpose of payment
Amblatory Care
Medigap Insurance
Security Rule
(APC) Ambulatory Patient Classifications
23. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
ee schedule
prepaid plan
Supplementary Medical Insurance
Resonable Charge
24. Medical staff member who is legally responsible for the care and treatment given to a patient.
business associate
attending physician
Privacy officer
abuse
25. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
(COB) Coordination of Benefits
authorization form
(PEC) Pre-existing condition
26. 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
Notice of Privacy Practices
(POS) Point-of Service Plan
nonprivileged information
(PCN) Primary Care Network
27. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
28. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
AMA
complience
Individually identifiable health information
breach of confidential communication
29. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
Security Rule
(POS) Point-of Service Plan
Experimental Procedures
(Non-par) Non-Participating Provider
30. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Open Enrollment
abuse
deductible
(AOB) Assignment of Benefits
31. 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
covered entity
epo
health care provider
Confidential communication
32. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
(PCP) Primary Care Physician
self-referral
complience
(OOPs) Out of Pocket Costs/Expenses
33. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(APC) Ambulatory Patient Classifications
Claim
covered entity
Privileged information
34. A health insurance enrollee chooses to see an out of network provider without authorization
Treating or performing physician
electronic media
claim
self-referral
35. Individually identifiable health information
state preemption
IIHI
health care provider
(DRG's)
36. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(DME) Durable Medical Equipment
Privileged information
preauthorization
Amblatory Care
37. 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
Consent form
Out of Network (OON)
Individually identifiable health information
Subscriber
38. The condition of being secluded from the presence or view of others.
consent
attending physician
crossover claim
privacy
39. Billing for services not performed
Individually identifiable health information
phantom billing
subscriber
benefit period
40. Health Information Portability and Accountability Act
HIPAA
pcp
security officer
ppo
41. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(PAC) Pre- Admission Certification
cash flow
complience plan
fraud
42. 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
pos
breach of confidential communication
econdary Payer
Beneficiary
43. 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
consulting physician
cash flow
hmo
(PCP) Primary Care Physician
44. A willful act by an employee of taking possession of an employer's money
(DRG's)
Embezzlement
(PEC) Pre-existing condition
business associate
45. 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
Subscriber
nonprivileged information
preauthorization
(PCN) Primary Care Network
46. What the insurance company will consider paying for as defined in the contract.
referral
Covered Expenses
Sub-acute Care
benefit period
47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
(POS) Point-of Service Plan
(DME) Durable Medical Equipment
Privacy officer
48. A patient claim is eligible for medicare and medicaid
crossover claim
(UR) Utilization review
nonprivileged information
privacy
49. 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
consulting physician
subscriber
Pre-certification
50. A willful act by an employee of taking possession of an employer's money
Maximum Out Of Pocket
Embezzlement
Experimental Procedures
Individually identifiable health information