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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 health insurance enrollee chooses to see an out of network provider without authorization
self-referral
referring physician
(EPO) Exclusive Provider Organization
open panel HMO
2. 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.
Covered Expenses
state preemption
business associate
(PCP) Primary Care Physician
3. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Subscriber
Consent form
(OOPs) Out of Pocket Costs/Expenses
etiquette
4. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
clearinghouse
pos
(EPO) Exclusive Provider Organization
security officer
5. What the insurance company will consider paying for as defined in the contract.
(COB) Coordination of Benefits
electronic media
Covered Expenses
Sub-acute Care
6. A structure for classifying outpatient services and procedures for purpose of payment
etiquette
epo
(APC) Ambulatory Patient Classifications
(UCR) Usual - Customary and Reasonable
7. 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
nonprivileged information
open panel HMO
Sub-acute Care
Embezzlement
8. 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.
Supplementary Medical Insurance
(Non-par) Non-Participating Provider
security officer
state preemption
9. 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
health care provider
nonprivileged information
(ERISA) Employee Retirement Income Security Act of 1974
(DME) Durable Medical Equipment
10. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(EPO) Exclusive Provider Organization
complience plan
fraud
Standard
11. Is a provider who sends the patients for testing or treatment
clearinghouse
closed panel HMO
referring physician
crossover claim
12. Is a provider who sends the patients for testing or treatment
referring physician
claim
complience plan
Referral
13. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
consent
Embezzlement
authorization form
14. Health Information Portability and Accountability Act
Medigap Insurance
Coordinated Coverage
HIPAA
Deductible
15. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
(EPO) Exclusive Provider Organization
privacy
HIPAA
16. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Preauthorization
Subscriber
cash flow
Maximum Out Of Pocket
17. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
prepaid plan
Pre-certification
Treating or performing physician
etiquette
18. Is the provider who renders a service to a patient
transaction
health care provider
open panel HMO
Treating or performing physician
19. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
e-health information management
abuse
transaction
20. The maximum amount a plan pays for a covered service
(PEC) Pre-existing condition
(PCP) Primary Care Physician
medical foundation
Allowed Expenses
21. 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
(DOS) Date of Service
(ABN) Advance Beneficiary Notice
Out of Network (OON)
cash flow
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.
pcp
business associate
Experimental Procedures
e-health information management
23. The amount of actual money available to the medical practice
cash flow
claim
nonprivileged information
security officer
24. 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
Individually identifiable health information
Assignment & Authorization
(APC) Ambulatory Patient Classifications
self-referral
25. Billing for services not performed
fraud
(Non-par) Non-Participating Provider
Treating or performing physician
phantom billing
26. This law mandates reporting - disclosure of grievance and appeals requirements and financial standards for group life and health. Self insured plans are regulated by this law
(PAC) Pre- Admission Certification
Subscriber
(ERISA) Employee Retirement Income Security Act of 1974
Out of Network (OON)
27. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
pcp
confidentiality
breach of confidential communication
(OOPs) Out of Pocket Costs/Expenses
28. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
medical foundation
confidentiality
(APC) Ambulatory Patient Classifications
29. 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
epo
(APC) Ambulatory Patient Classifications
(EPO) Exclusive Provider Organization
Experimental Procedures
30. 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.
(PCN) Primary Care Network
state preemption
(DOS) Date of Service
(AOB) Assignment of Benefits
31. The condition of being secluded from the presence or view of others.
(TPA) Third Party Administrator
privacy
complience
transaction
32. 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
(AOB) Assignment of Benefits
econdary Payer
(COBRA)
Open Enrollment
33. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(POS) Point-of Service Plan
(OOPs) Out of Pocket Costs/Expenses
health care provider
referral
34. 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
attending physician
(ABN) Advance Beneficiary Notice
Preauthorization
(DRG's)
35. 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.
Claim
Protected health information
Notice of Privacy Practices
open panel HMO
36. 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
crossover claim
Supplementary Medical Insurance
(UR) Utilization review
Amblatory Care
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
nonprivileged information
Claim
fraud
Deductible
38. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(EPO) Exclusive Provider Organization
covered entity
breach of confidential communication
consulting physician
39. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
ee schedule
(PCN) Primary Care Network
self-referral
40. Verbal or written agreement that gives approval to some action - situation - or statement.
deductible
consent
attending physician
ids
41. 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
pcp
(DME) Durable Medical Equipment
Claim
complience plan
42. A specific period of time in which employees may change insurance plans and medical groups offered by their employer and have the new insurance effective at a later date
Open Enrollment
ids
(PCN) Primary Care Network
Preauthorization
43. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Amblatory Care
Consent form
deductible
closed panel HMO
44. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
econdary Payer
(OOPs) Out of Pocket Costs/Expenses
health care provider
(AOB) Assignment of Benefits
45. Customs - rules of conduct - courtesy - and manners of the medical profession
AMA
electronic media
etiquette
Privacy officer
46. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Out of Network (OON)
(Non-par) Non-Participating Provider
benefit period
47. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
breach of confidential communication
e-health information management
Allowed Expenses
electronic media
48. A health insurance enrollee chooses to see an out of network provider without authorization
phantom billing
referring physician
preauthorization
self-referral
49. An organization of provider sites with a contracted relationship that offer services
Notice of Privacy Practices
ids
(ERISA) Employee Retirement Income Security Act of 1974
econdary Payer
50. 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
ppo
crossover claim
prepaid plan
IIHI