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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. Approval or consent by a primary physician for patient referral to ancillary services and specialists
closed panel HMO
etiquette
Referral
claim
2. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Allowed Expenses
security officer
complience plan
confidentiality
3. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
consent
AMA
ordering physician
(UR) Utilization review
4. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
open panel HMO
Out of Network (OON)
Medigap Insurance
5. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
complience
transaction
self-referral
6. An organization of provider sites with a contracted relationship that offer services
benefit period
Amblatory Care
ids
(DME) Durable Medical Equipment
7. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
deductible
Embezzlement
ordering physician
disclosure
8. 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
abuse
Notice of Privacy Practices
electronic media
9. 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
nonprivileged information
Specialist
(Non-par) Non-Participating Provider
prepaid plan
10. 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
(DME) Durable Medical Equipment
(EPO) Exclusive Provider Organization
phantom billing
11. 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.
Security Rule
(COB) Coordination of Benefits
Privacy officer
Sub-acute Care
12. Medicare's method of paying acute care hospitals for inpatient care
Supplementary Medical Insurance
(AOB) Assignment of Benefits
self-referral
(PPS) Hospital Impatient Prospective Payment System
13. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
pcp
(PCP) Primary Care Physician
(PAC) Pre- Admission Certification
(UCR) Usual - Customary and Reasonable
14. The amount of actual money available to the medical practice
medical foundation
Embezzlement
cash flow
(ERISA) Employee Retirement Income Security Act of 1974
15. Is the provider who renders a service to a patient
AMA
Treating or performing physician
consulting physician
Maximum Out Of Pocket
16. 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
disclosure
ordering physician
consulting physician
17. American Medical Association
phantom billing
(DME) Durable Medical Equipment
AMA
medical foundation
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
Beneficiary
medical foundation
(ABN) Advance Beneficiary Notice
19. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Covered Expenses
(DOS) Date of Service
attending physician
20. Someone who is eligible for or receiving benefits under an insurance policy or plan
Referral
Beneficiary
econdary Payer
crossover claim
21. 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
state preemption
(DCI) Duplicate Coverage Inquiry
Experimental Procedures
(COBRA)
22. Standards of conduct generally accepted as a moral guide for behavior.
hmo
ethics
(PEC) Pre-existing condition
open panel HMO
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
(DRG's)
Pre-existing Condition Exclusion
nonprivileged information
complience
24. 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
pos
claim
econdary Payer
Amblatory Care
25. The maximum amount a plan pays for a covered service
benefit period
Allowed Expenses
Claim
cash flow
26. 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
Coordinated Coverage
covered entity
Open Enrollment
Sub-acute Care
27. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
(POS) Point-of Service Plan
(COBRA)
Deductible
28. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Privacy officer
Specialist
nonprivileged information
29. An intentional misrepresentation of the facts to deceive or mislead another.
(DME) Durable Medical Equipment
pcp
Protected health information
fraud
30. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
Confidential communication
covered entity
consulting physician
31. The period of time that payment for Medicare inpatient hospital benefits are available
cash flow
Standard
benefit period
Assignment & Authorization
32. 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)
referral
Consent form
confidentiality
Protected health information
33. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
attending physician
ordering physician
Resonable Charge
econdary Payer
34. 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
(COBRA)
AMA
subscriber
disclosure
35. 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
Subscriber
preauthorization
Individually identifiable health information
36. What the insurance company will consider paying for as defined in the contract.
(PCP) Primary Care Physician
state preemption
Covered Expenses
premium
37. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
phantom billing
Referral
(DCI) Duplicate Coverage Inquiry
premium
38. 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
benefit period
covered entity
Sub-acute Care
nonprivileged information
39. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
cash flow
(DME) Durable Medical Equipment
pcp
Specialist
40. A willful act by an employee of taking possession of an employer's money
security officer
ordering physician
closed panel HMO
Embezzlement
41. 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
(UCR) Usual - Customary and Reasonable
prepaid plan
(ABN) Advance Beneficiary Notice
ppo
42. Standards of conduct generally accepted as a moral guide for behavior.
(PCN) Primary Care Network
privacy
ethics
subscriber
43. The amount of actual money available to the medical practice
cash flow
Covered Expenses
Confidential communication
(COBRA)
44. 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 form
self-referral
Supplementary Medical Insurance
prepaid plan
45. 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
open panel HMO
(PCN) Primary Care Network
Open Enrollment
privacy
46. 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.
transaction
(EPO) Exclusive Provider Organization
Individually identifiable health information
security officer
47. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
state preemption
crossover claim
Treating or performing physician
48. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
preauthorization
privacy
(PCP) Primary Care Physician
abuse
49. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(DCI) Duplicate Coverage Inquiry
claim
Treating or performing physician
Experimental Procedures
50. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Privacy officer
clearinghouse
privacy
(UCR) Usual - Customary and Reasonable