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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.
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Match each statement with the correct term.
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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 monthly fee paid by the insured for specific medical insurance coverage
premium
hmo
deductible
Supplementary Medical Insurance
2. Integrating benefits payable under more than one health insurance.
Covered Expenses
(PPS) Hospital Impatient Prospective Payment System
Coordinated Coverage
covered entity
3. 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.
covered entity
Treating or performing physician
Assignment & Authorization
Notice of Privacy Practices
4. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment
Medigap Insurance
Confidential communication
(DME) Durable Medical Equipment
etiquette
5. Is the provider who renders a service to a patient
Experimental Procedures
complience
Treating or performing physician
(APC) Ambulatory Patient Classifications
6. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
confidentiality
transaction
(DME) Durable Medical Equipment
7. 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
Privacy officer
Covered Expenses
Security Rule
open panel HMO
8. Medical services provided on an outpatient basis
business associate
electronic media
Out of Network (OON)
Amblatory Care
9. An organization of provider sites with a contracted relationship that offer services
Resonable Charge
Covered Expenses
privacy
ids
10. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Sub-acute Care
Medigap Insurance
business associate
e-health information management
11. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(Non-par) Non-Participating Provider
complience plan
pos
claim
12. Billing for services not performed
(PCP) Primary Care Physician
phantom billing
Confidential communication
(UR) Utilization review
13. A nonprofit integrated delivery system
Maximum Out Of Pocket
attending physician
consulting physician
medical foundation
14. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Treating or performing physician
ethics
Standard
Subscriber
15. 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.
business associate
IIHI
Coordinated Coverage
Subscriber
16. 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
consulting physician
Allowed Expenses
(COBRA)
AMA
17. 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
fraud
deductible
Consent form
18. 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.
Notice of Privacy Practices
Deductible
Open Enrollment
AMA
19. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
phantom billing
(OOPs) Out of Pocket Costs/Expenses
hmo
20. 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
ppo
business associate
preauthorization
21. The maximum amount a plan pays for a covered service
Allowed Expenses
Out of Network (OON)
(TPA) Third Party Administrator
econdary Payer
22. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
pos
complience plan
(POS) Point-of Service Plan
hmo
23. 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
Allowed Expenses
Out of Network (OON)
(PCP) Primary Care Physician
clearinghouse
24. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Medigap Insurance
Claim
clearinghouse
epo
25. A rule - condition - or requirement
Standard
Confidential communication
Privacy officer
Medigap Insurance
26. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor
abuse
Assignment & Authorization
medical foundation
abuse
27. A structure for classifying outpatient services and procedures for purpose of payment
Resonable Charge
(TPA) Third Party Administrator
claim
(APC) Ambulatory Patient Classifications
28. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
state preemption
(POS) Point-of Service Plan
self-referral
29. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
Pre-certification
breach of confidential communication
(DCI) Duplicate Coverage Inquiry
30. 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
open panel HMO
ppo
prepaid plan
HIPAA
31. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
state preemption
consent
deductible
32. The maximum amount a plan pays for a covered service
Standard
Sub-acute Care
Allowed Expenses
(UCR) Usual - Customary and Reasonable
33. 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
ethics
Sub-acute Care
Protected health information
Notice of Privacy Practices
34. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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35. A document signed by the patient that is needed for use and disclosure of protected health information for purposes other than treatment - payment or health care operations
Allowed Expenses
claim
(OOPs) Out of Pocket Costs/Expenses
authorization form
36. 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
premium
Embezzlement
Participating Provider
abuse
37. Individually identifiable health information
epo
Standard
IIHI
(DRG's)
38. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
preauthorization
referral
epo
disclosure
39. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
preauthorization
(UCR) Usual - Customary and Reasonable
state preemption
40. 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
attending physician
Standard
crossover claim
Out of Network (OON)
41. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Preauthorization
pcp
complience plan
Pre-certification
42. The condition of being secluded from the presence or view of others.
privacy
ordering physician
Beneficiary
deductible
43. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
complience plan
Subscriber
Network
Participating Provider
44. The condition of being secluded from the presence or view of others.
(ABN) Advance Beneficiary Notice
privacy
phantom billing
Assignment & Authorization
45. Medical equipment which: can withstand repeated use - is used to serve a medical purpose - and appropriate for use in the home. Examples include hospital beds - wheelchairs and oxygen equipment
(DOS) Date of Service
(COB) Coordination of Benefits
(DME) Durable Medical Equipment
(POS) Point-of Service Plan
46. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(DRG's)
Covered Expenses
(PCP) Primary Care Physician
claim
47. A rule - condition - or requirement
Standard
Privacy officer
Referral
(DME) Durable Medical Equipment
48. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
attending physician
Treating or performing physician
Deductible
Network
49. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Resonable Charge
consent
Specialist
Covered Expenses
50. A monthly fee paid by the insured for specific medical insurance coverage
(UR) Utilization review
premium
consulting physician
business associate
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