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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.
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. 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
cash flow
covered entity
clearinghouse
Embezzlement
2. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
fraud
nonprivileged information
consent
Claim
3. 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
closed panel HMO
Participating Provider
(DOS) Date of Service
consulting physician
4. A willful act by an employee of taking possession of an employer's money
medical foundation
hmo
(Non-par) Non-Participating Provider
Embezzlement
5. American Medical Association
security officer
open panel HMO
Pre-certification
AMA
6. 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
IIHI
(ERISA) Employee Retirement Income Security Act of 1974
self-referral
Sub-acute Care
7. Someone who is eligible for or receiving benefits under an insurance policy or plan
breach of confidential communication
Pre-existing Condition Exclusion
(AOB) Assignment of Benefits
Beneficiary
8. 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
Treating or performing physician
(EPO) Exclusive Provider Organization
(PCN) Primary Care Network
ordering physician
9. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
econdary Payer
hmo
(OOPs) Out of Pocket Costs/Expenses
Security Rule
10. American Medical Association
AMA
Security Rule
ee schedule
Preauthorization
11. The period of time that payment for Medicare inpatient hospital benefits are available
Preauthorization
benefit period
e-health information management
Coordinated Coverage
12. An intentional misrepresentation of the facts to deceive or mislead another.
(PAC) Pre- Admission Certification
fraud
(DCI) Duplicate Coverage Inquiry
open panel HMO
13. Approval or consent by a primary physician for patient referral to ancillary services and specialists
etiquette
Pre-existing Condition Exclusion
deductible
Referral
14. 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
Security Rule
nonprivileged information
(UR) Utilization review
prepaid plan
15. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
(COBRA)
Individually identifiable health information
Medigap Insurance
16. The condition of being secluded from the presence or view of others.
(PCP) Primary Care Physician
privacy
cash flow
Treating or performing physician
17. 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
Specialist
Treating or performing physician
HIPAA
Assignment & Authorization
18. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Embezzlement
Pre-existing Condition Exclusion
Beneficiary
Subscriber
19. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
ethics
ppo
Network
consent
20. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
clearinghouse
Sub-acute Care
Network
Coordinated Coverage
21. The maximum amount a plan pays for a covered service
Consent form
Allowed Expenses
ppo
Assignment & Authorization
22. A health insurance enrollee chooses to see an out of network provider without authorization
Supplementary Medical Insurance
(UCR) Usual - Customary and Reasonable
self-referral
Privileged information
23. 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
(Non-par) Non-Participating Provider
ee schedule
Coordinated Coverage
24. A patient claim is eligible for medicare and medicaid
Protected health information
authorization form
attending physician
crossover claim
25. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
epo
(PEC) Pre-existing condition
security officer
(DRG's)
26. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
benefit period
clearinghouse
(PEC) Pre-existing condition
27. 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
(POS) Point-of Service Plan
Sub-acute Care
Beneficiary
econdary Payer
28. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
medical foundation
Protected health information
(COB) Coordination of Benefits
29. 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
Privacy officer
Consent form
fraud
econdary Payer
30. The period of time that payment for Medicare inpatient hospital benefits are available
business associate
deductible
Covered Expenses
benefit period
31. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
business associate
ethics
Resonable Charge
state preemption
32. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Participating Provider
Subscriber
pos
33. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
(UCR) Usual - Customary and Reasonable
(COB) Coordination of Benefits
(PPS) Hospital Impatient Prospective Payment System
Individually identifiable health information
34. 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.
Treating or performing physician
health care provider
confidentiality
Coordinated Coverage
35. 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
state preemption
covered entity
Out of Network (OON)
Pre-certification
36. An intentional misrepresentation of the facts to deceive or mislead another.
ee schedule
(TPA) Third Party Administrator
fraud
ee schedule
37. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(DME) Durable Medical Equipment
Beneficiary
pcp
ids
38. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Pre-existing Condition Exclusion
Assignment & Authorization
Participating Provider
39. 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)
business associate
Allowed Expenses
Consent form
health care provider
40. 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
Supplementary Medical Insurance
phantom billing
ppo
covered entity
41. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
(PEC) Pre-existing condition
Treating or performing physician
(TPA) Third Party Administrator
42. 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.
privacy
Consent form
Maximum Out Of Pocket
business associate
43. 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
(EPO) Exclusive Provider Organization
security officer
Pre-existing Condition Exclusion
(AOB) Assignment of Benefits
44. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Referral
Individually identifiable health information
Consent form
preauthorization
45. 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
Assignment & Authorization
(AOB) Assignment of Benefits
(PCN) Primary Care Network
Individually identifiable health information
46. 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
(ERISA) Employee Retirement Income Security Act of 1974
Experimental Procedures
(DCI) Duplicate Coverage Inquiry
Security Rule
47. The dates of healthcare services were provided to the beneficiary
cash flow
(DOS) Date of Service
(PCP) Primary Care Physician
(ERISA) Employee Retirement Income Security Act of 1974
48. Billing for services not performed
Pre-certification
phantom billing
claim
Maximum Out Of Pocket
49. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
e-health information management
Referral
Covered Expenses
claim
50. 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
(PCP) Primary Care Physician
Maximum Out Of Pocket
crossover claim
ethics