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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. Customs - rules of conduct - courtesy - and manners of the medical profession
(TPA) Third Party Administrator
consulting physician
consent
etiquette
2. A patient claim is eligible for medicare and medicaid
prepaid plan
Participating Provider
e-health information management
crossover claim
3. A list of the amount to be paid by an insurance company for each procedure service
benefit period
ee schedule
pcp
HIPAA
4. 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
(PCP) Primary Care Physician
cash flow
Experimental Procedures
5. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Allowed Expenses
consulting physician
business associate
(EPO) Exclusive Provider Organization
6. 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
claim
Supplementary Medical Insurance
benefit period
7. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
fraud
crossover claim
referring physician
(POS) Point-of Service Plan
8. Someone who is eligible for or receiving benefits under an insurance policy or plan
(DCI) Duplicate Coverage Inquiry
IIHI
privacy
Beneficiary
9. 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
(PAC) Pre- Admission Certification
phantom billing
Preauthorization
10. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
prepaid plan
(TPA) Third Party Administrator
Embezzlement
pcp
11. 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
Subscriber
Network
Allowed Expenses
12. 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)
AMA
hmo
Consent form
ethics
13. A structure for classifying outpatient services and procedures for purpose of payment
Sub-acute Care
ordering physician
Maximum Out Of Pocket
(APC) Ambulatory Patient Classifications
14. The condition of being secluded from the presence or view of others.
(POS) Point-of Service Plan
(PCN) Primary Care Network
privacy
(PPS) Hospital Impatient Prospective Payment System
15. Verbal or written agreement that gives approval to some action - situation - or statement.
privacy
Covered Expenses
consent
e-health information management
16. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
clearinghouse
preauthorization
premium
Experimental Procedures
17. 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
(AOB) Assignment of Benefits
Specialist
(DOS) Date of Service
18. 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
Individually identifiable health information
Preauthorization
referral
Notice of Privacy Practices
19. 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
ppo
Protected health information
epo
20. 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.
Confidential communication
referral
Privileged information
(PAC) Pre- Admission Certification
21. Integrating benefits payable under more than one health insurance.
self-referral
Participating Provider
Coordinated Coverage
Medigap Insurance
22. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
crossover claim
Sub-acute Care
(POS) Point-of Service Plan
hmo
23. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
(UR) Utilization review
business associate
Treating or performing physician
24. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
etiquette
consulting physician
(UR) Utilization review
abuse
25. 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
Consent form
deductible
Standard
26. Medical services provided on an outpatient basis
Amblatory Care
clearinghouse
Claim
consulting physician
27. 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
consulting physician
complience plan
(COB) Coordination of Benefits
Maximum Out Of Pocket
28. 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
(COBRA)
Security Rule
self-referral
(ERISA) Employee Retirement Income Security Act of 1974
29. 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
ids
(DCI) Duplicate Coverage Inquiry
preauthorization
30. 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
(DRG's)
Protected health information
Out of Network (OON)
IIHI
31. A nonprofit integrated delivery system
medical foundation
AMA
pcp
Pre-existing Condition Exclusion
32. Medical services provided on an outpatient basis
epo
medical foundation
deductible
Amblatory Care
33. 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
(COB) Coordination of Benefits
(DOS) Date of Service
Individually identifiable health information
open panel HMO
34. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
hmo
Coordinated Coverage
disclosure
Notice of Privacy Practices
35. 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
Deductible
pos
attending physician
IIHI
36. 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
(APC) Ambulatory Patient Classifications
breach of confidential communication
Medigap Insurance
37. 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
electronic media
ppo
nonprivileged information
referring physician
38. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Supplementary Medical Insurance
complience plan
Individually identifiable health information
39. 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
Protected health information
referring physician
Participating Provider
40. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
authorization form
Standard
Pre-existing Condition Exclusion
electronic media
41. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(DOS) Date of Service
epo
Medigap Insurance
open panel HMO
42. Managed care product that offers enrollees a choice among options when they need medical services - rather than when they enroll in the plan. Enrollees may use providers outside the managed care network - but usually at higher cost
(POS) Point-of Service Plan
phantom billing
subscriber
fraud
43. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
claim
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
referral
44. 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.
benefit period
ids
prepaid plan
Privacy officer
45. Someone who is eligible for or receiving benefits under an insurance policy or plan
Pre-certification
Beneficiary
open panel HMO
confidentiality
46. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Deductible
state preemption
(OOPs) Out of Pocket Costs/Expenses
(ABN) Advance Beneficiary Notice
47. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
prepaid plan
abuse
confidentiality
Security Rule
48. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
(OOPs) Out of Pocket Costs/Expenses
consulting physician
disclosure
subscriber
49. The Medicare program that pays for a protion of the cost of physicians' services - outpatient hospital services and other related medical and health services for voluntarily insured aged and disabled individuals
Supplementary Medical Insurance
Participating Provider
health care provider
Amblatory Care
50. Medical staff member who is legally responsible for the care and treatment given to a patient.
self-referral
attending physician
hmo
Specialist