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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. American Medical Association
Referral
complience
AMA
Standard
2. Individually identifiable health information
Notice of Privacy Practices
(AOB) Assignment of Benefits
nonprivileged information
IIHI
3. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
covered entity
(OOPs) Out of Pocket Costs/Expenses
(PPS) Hospital Impatient Prospective Payment System
4. Usually described as a comprehensive inpatient program for those who have experienced a serious illness - injury or disease but who do not require intensive hospital services. This includes infusion therapy - respiratory care - cardiac services - wou
Out of Network (OON)
Sub-acute Care
Embezzlement
Pre-existing Condition Exclusion
5. 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
Confidential communication
referral
(PCP) Primary Care Physician
Privileged information
6. Individually identifiable health information
IIHI
Subscriber
confidentiality
Network
7. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
phantom billing
claim
transaction
8. The transmission of information between two parties to carry out financial or administrative activities related to health care.
clearinghouse
(DCI) Duplicate Coverage Inquiry
confidentiality
transaction
9. 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.
confidentiality
business associate
abuse
AMA
10. Is a provider who sends the patients for testing or treatment
privacy
privacy
referring physician
fraud
11. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Maximum Out Of Pocket
prepaid plan
consulting physician
preauthorization
12. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
phantom billing
(UR) Utilization review
Medigap Insurance
(COBRA)
13. A privileged communication that may be disclosed only with the patient's permission.
covered entity
transaction
Confidential communication
security officer
14. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(ERISA) Employee Retirement Income Security Act of 1974
Coordinated Coverage
Pre-certification
abuse
15. The maximum amount a plan pays for a covered service
claim
HIPAA
Sub-acute Care
Allowed Expenses
16. Medical services provided on an outpatient basis
prepaid plan
pos
IIHI
Amblatory Care
17. A review of the need for inpatient hospital care - completed before the actual admission
(EPO) Exclusive Provider Organization
disclosure
Sub-acute Care
(PAC) Pre- Admission Certification
18. 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
econdary Payer
fraud
Consent form
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
Claim
medical foundation
(ABN) Advance Beneficiary Notice
Coordinated Coverage
20. The dates of healthcare services were provided to the beneficiary
(ABN) Advance Beneficiary Notice
(EPO) Exclusive Provider Organization
ppo
(DOS) Date of Service
21. Verbal or written agreement that gives approval to some action - situation - or statement.
ids
(OOPs) Out of Pocket Costs/Expenses
epo
consent
22. 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.
open panel HMO
hmo
Covered Expenses
Notice of Privacy Practices
23. 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
electronic media
confidentiality
Maximum Out Of Pocket
pos
24. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Treating or performing physician
(PCP) Primary Care Physician
breach of confidential communication
Pre-certification
25. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
authorization form
ordering physician
(COBRA)
Covered Expenses
26. 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
Embezzlement
disclosure
(APC) Ambulatory Patient Classifications
27. 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
ethics
disclosure
(DME) Durable Medical Equipment
epo
28. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
covered entity
Privileged information
confidentiality
(COBRA)
29. Is a provider who sends the patients for testing or treatment
clearinghouse
Subscriber
econdary Payer
referring physician
30. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Individually identifiable health information
transaction
ordering physician
(DRG's)
31. Unauthorized release of information
ids
pcp
Supplementary Medical Insurance
breach of confidential communication
32. 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
ethics
hmo
Coordinated Coverage
covered entity
33. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Participating Provider
HIPAA
(OOPs) Out of Pocket Costs/Expenses
(TPA) Third Party Administrator
34. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
state preemption
Claim
(Non-par) Non-Participating Provider
referral
35. 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
complience plan
authorization form
(AOB) Assignment of Benefits
36. 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
HIPAA
authorization form
37. 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
(COB) Coordination of Benefits
Deductible
ethics
Pre-certification
38. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
benefit period
subscriber
privacy
Standard
39. 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.
Subscriber
(PPS) Hospital Impatient Prospective Payment System
prepaid plan
security officer
40. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Subscriber
econdary Payer
Treating or performing physician
consulting physician
41. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
disclosure
(UCR) Usual - Customary and Reasonable
Experimental Procedures
Treating or performing physician
42. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Specialist
Privileged information
pcp
43. 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
Preauthorization
Covered Expenses
open panel HMO
Assignment & Authorization
44. A privileged communication that may be disclosed only with the patient's permission.
hmo
(ERISA) Employee Retirement Income Security Act of 1974
Confidential communication
referral
45. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
abuse
(COB) Coordination of Benefits
IIHI
(DCI) Duplicate Coverage Inquiry
46. Customs - rules of conduct - courtesy - and manners of the medical profession
claim
health care provider
etiquette
e-health information management
47. Unauthorized release of information
HIPAA
(COBRA)
(DME) Durable Medical Equipment
breach of confidential communication
48. 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.
referring physician
(APC) Ambulatory Patient Classifications
business associate
confidentiality
49. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Out of Network (OON)
subscriber
Treating or performing physician
consulting physician
50. 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
Specialist
Preauthorization
pos