SUBJECTS
|
BROWSE
|
CAREER CENTER
|
POPULAR
|
JOIN
|
LOGIN
Business Skills
|
Soft Skills
|
Basic Literacy
|
Certifications
About
|
Help
|
Privacy
|
Terms
|
Email
Search
Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
Start Test
Study First
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 fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Treating or performing physician
Privileged information
Resonable Charge
(DOS) Date of Service
2. 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
Amblatory Care
(PAC) Pre- Admission Certification
(ABN) Advance Beneficiary Notice
(PPS) Hospital Impatient Prospective Payment System
3. 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.
Beneficiary
(ERISA) Employee Retirement Income Security Act of 1974
Protected health information
fraud
4. 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
privacy
(Non-par) Non-Participating Provider
Resonable Charge
nonprivileged information
5. An intentional misrepresentation of the facts to deceive or mislead another.
Experimental Procedures
econdary Payer
Pre-existing Condition Exclusion
fraud
6. 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
Standard
privacy
Pre-existing Condition Exclusion
7. A rule - condition - or requirement
(PEC) Pre-existing condition
Standard
complience plan
electronic media
8. 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
Confidential communication
nonprivileged information
(OOPs) Out of Pocket Costs/Expenses
deductible
9. 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
nonprivileged information
Pre-existing Condition Exclusion
open panel HMO
security officer
10. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PAC) Pre- Admission Certification
(PEC) Pre-existing condition
(COBRA)
Network
11. Individually identifiable health information
pos
Experimental Procedures
Embezzlement
IIHI
12. 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
(AOB) Assignment of Benefits
epo
complience plan
(POS) Point-of Service Plan
13. A provision that apples when a person is covered under more than one group medical program
Resonable Charge
ids
IIHI
(COB) Coordination of Benefits
14. 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
Standard
(EPO) Exclusive Provider Organization
(APC) Ambulatory Patient Classifications
Supplementary Medical Insurance
15. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
attending physician
consent
disclosure
ethics
16. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
econdary Payer
subscriber
hmo
(DME) Durable Medical Equipment
17. A provision that apples when a person is covered under more than one group medical program
HIPAA
(COB) Coordination of Benefits
open panel HMO
closed panel HMO
18. 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
AMA
(COBRA)
Open Enrollment
pcp
19. 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
pcp
Allowed Expenses
ordering physician
(PCN) Primary Care Network
20. 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
prepaid plan
(ABN) Advance Beneficiary Notice
Beneficiary
subscriber
21. Billing for services not performed
Referral
breach of confidential communication
health care provider
phantom billing
22. 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.
complience
econdary Payer
Maximum Out Of Pocket
business associate
23. 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
crossover claim
consent
Pre-existing Condition Exclusion
(EPO) Exclusive Provider Organization
24. Approval or consent by a primary physician for patient referral to ancillary services and specialists
ids
(DRG's)
Referral
Preauthorization
25. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
pcp
Network
health care provider
26. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
pos
covered entity
e-health information management
Claim
27. Any healthcare services - that are determined by the insurance plan to be either; not generally accepted by informed healthcare professionals in the U.S. as efective in treating the condition - illness or diagnosis for which their use is proposed; or
(PCP) Primary Care Physician
Preauthorization
Experimental Procedures
clearinghouse
28. 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.
referring physician
Subscriber
Protected health information
(PEC) Pre-existing condition
29. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
preauthorization
abuse
Confidential communication
Specialist
30. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Sub-acute Care
closed panel HMO
(TPA) Third Party Administrator
health care provider
31. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
ordering physician
(ABN) Advance Beneficiary Notice
Treating or performing physician
32. The maximum amount a plan pays for a covered service
benefit period
Allowed Expenses
AMA
Sub-acute Care
33. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Out of Network (OON)
transaction
IIHI
abuse
34. American Medical Association
Resonable Charge
(DCI) Duplicate Coverage Inquiry
(AOB) Assignment of Benefits
AMA
35. A list of the amount to be paid by an insurance company for each procedure service
Notice of Privacy Practices
(POS) Point-of Service Plan
ordering physician
ee schedule
36. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
pos
epo
Maximum Out Of Pocket
37. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
econdary Payer
consulting physician
authorization form
Network
38. 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
(UR) Utilization review
Network
(PPS) Hospital Impatient Prospective Payment System
39. 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
Assignment & Authorization
hmo
Deductible
Assignment & Authorization
40. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Protected health information
Consent form
(PCN) Primary Care Network
Pre-certification
41. 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
breach of confidential communication
Deductible
Out of Network (OON)
econdary Payer
42. A patient claim is eligible for medicare and medicaid
Consent form
crossover claim
preauthorization
Subscriber
43. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
hmo
IIHI
abuse
security officer
44. 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
confidentiality
Sub-acute Care
Network
Coordinated Coverage
45. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(ERISA) Employee Retirement Income Security Act of 1974
Pre-existing Condition Exclusion
transaction
Medigap Insurance
46. Unauthorized release of information
attending physician
transaction
complience
breach of confidential communication
47. A willful act by an employee of taking possession of an employer's money
closed panel HMO
Allowed Expenses
Embezzlement
health care provider
48. 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
(TPA) Third Party Administrator
Amblatory Care
etiquette
pos
49. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Embezzlement
Standard
Resonable Charge
consulting physician
50. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
transaction
consulting physician
Consent form
(AOB) Assignment of Benefits