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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 review of the need for inpatient hospital care - completed before the actual admission
Protected health information
(PAC) Pre- Admission Certification
IIHI
consulting physician
2. 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
Pre-existing Condition Exclusion
Pre-certification
IIHI
epo
3. 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
ppo
closed panel HMO
Specialist
closed panel HMO
4. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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5. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
etiquette
Privileged information
state preemption
(OOPs) Out of Pocket Costs/Expenses
6. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(PPS) Hospital Impatient Prospective Payment System
Pre-existing Condition Exclusion
Open Enrollment
abuse
7. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Covered Expenses
confidentiality
deductible
security officer
8. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
Supplementary Medical Insurance
AMA
(APC) Ambulatory Patient Classifications
9. Unauthorized release of information
epo
health care provider
breach of confidential communication
authorization form
10. A patient claim is eligible for medicare and medicaid
crossover claim
Medigap Insurance
preauthorization
Out of Network (OON)
11. The maximum amount a plan pays for a covered service
Privileged information
Participating Provider
complience plan
Allowed Expenses
12. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Embezzlement
(UR) Utilization review
prepaid plan
(COB) Coordination of Benefits
13. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
abuse
Covered Expenses
attending physician
14. 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.
Privacy officer
Experimental Procedures
Security Rule
ppo
15. 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
Network
Preauthorization
Claim
e-health information management
16. What the insurance company will consider paying for as defined in the contract.
Amblatory Care
closed panel HMO
Covered Expenses
Treating or performing physician
17. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
(PEC) Pre-existing condition
Participating Provider
referral
18. 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
premium
complience plan
Embezzlement
covered entity
19. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
IIHI
(DCI) Duplicate Coverage Inquiry
complience plan
confidentiality
20. 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
ee schedule
(TPA) Third Party Administrator
pcp
21. 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)
crossover claim
(COB) Coordination of Benefits
epo
Consent form
22. An organization of provider sites with a contracted relationship that offer services
Supplementary Medical Insurance
Maximum Out Of Pocket
ids
hmo
23. 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
(ABN) Advance Beneficiary Notice
Amblatory Care
authorization form
pos
24. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
covered entity
(Non-par) Non-Participating Provider
closed panel HMO
25. Is the provider who renders a service to a patient
Treating or performing physician
(DRG's)
Notice of Privacy Practices
IIHI
26. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
Medigap Insurance
Notice of Privacy Practices
(DRG's)
27. What the insurance company will consider paying for as defined in the contract.
hmo
referring physician
Coordinated Coverage
Covered Expenses
28. Is a provider who sends the patients for testing or treatment
pcp
referring physician
HIPAA
Pre-existing Condition Exclusion
29. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Consent form
IIHI
(COBRA)
disclosure
30. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
open panel HMO
preauthorization
(PCN) Primary Care Network
31. 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)
pcp
(POS) Point-of Service Plan
Consent form
ids
32. A patient claim is eligible for medicare and medicaid
crossover claim
subscriber
deductible
(PCP) Primary Care Physician
33. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
ppo
premium
Supplementary Medical Insurance
34. Health Information Portability and Accountability Act
HIPAA
benefit period
(EPO) Exclusive Provider Organization
referring physician
35. Medical services provided on an outpatient basis
ordering physician
Treating or performing physician
authorization form
Amblatory Care
36. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(DOS) Date of Service
Out of Network (OON)
Resonable Charge
complience
37. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
abuse
(DOS) Date of Service
Protected health information
38. 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
ee schedule
abuse
Confidential communication
39. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Individually identifiable health information
Resonable Charge
Notice of Privacy Practices
nonprivileged information
40. 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
Privileged information
Pre-existing Condition Exclusion
transaction
ordering physician
41. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Medigap Insurance
referral
Participating Provider
nonprivileged information
42. 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
epo
HIPAA
Participating Provider
breach of confidential communication
43. A willful act by an employee of taking possession of an employer's money
Notice of Privacy Practices
Embezzlement
prepaid plan
Participating Provider
44. 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
abuse
pcp
phantom billing
Deductible
45. A health insurance enrollee chooses to see an out of network provider without authorization
privacy
consulting physician
cash flow
self-referral
46. The amount of actual money available to the medical practice
premium
Standard
cash flow
(DCI) Duplicate Coverage Inquiry
47. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
abuse
ids
(TPA) Third Party Administrator
Open Enrollment
48. Unauthorized release of information
Sub-acute Care
Treating or performing physician
confidentiality
breach of confidential communication
49. Someone who is eligible for or receiving benefits under an insurance policy or plan
Assignment & Authorization
crossover claim
Pre-certification
Beneficiary
50. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Covered Expenses
e-health information management
pcp
confidentiality