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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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study here
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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. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
subscriber
Network
Referral
2. 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
clearinghouse
hmo
pos
prepaid plan
3. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
crossover claim
Medigap Insurance
Out of Network (OON)
4. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
closed panel HMO
(PCP) Primary Care Physician
clearinghouse
authorization form
5. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(ERISA) Employee Retirement Income Security Act of 1974
HIPAA
(OOPs) Out of Pocket Costs/Expenses
Maximum Out Of Pocket
6. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
benefit period
deductible
(AOB) Assignment of Benefits
7. 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
(DOS) Date of Service
Protected health information
clearinghouse
8. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
nonprivileged information
crossover claim
(EPO) Exclusive Provider Organization
business associate
9. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Assignment & Authorization
ordering physician
ee schedule
Deductible
10. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(OOPs) Out of Pocket Costs/Expenses
Pre-certification
breach of confidential communication
consent
11. 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
Covered Expenses
e-health information management
Supplementary Medical Insurance
Subscriber
12. 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
(PCN) Primary Care Network
Referral
(APC) Ambulatory Patient Classifications
13. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Maximum Out Of Pocket
Beneficiary
Medigap Insurance
14. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
consent
Standard
electronic media
privacy
15. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
closed panel HMO
e-health information management
Sub-acute Care
referral
16. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
(DME) Durable Medical Equipment
medical foundation
(COB) Coordination of Benefits
17. A willful act by an employee of taking possession of an employer's money
Embezzlement
ids
HIPAA
(PCN) Primary Care Network
18. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
electronic media
preauthorization
complience
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
(Non-par) Non-Participating Provider
consulting physician
ppo
epo
20. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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21. Standards of conduct generally accepted as a moral guide for behavior.
Individually identifiable health information
ethics
Pre-existing Condition Exclusion
subscriber
22. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(PAC) Pre- Admission Certification
(UCR) Usual - Customary and Reasonable
(Non-par) Non-Participating Provider
Standard
23. Individually identifiable health information
IIHI
Out of Network (OON)
Participating Provider
(APC) Ambulatory Patient Classifications
24. 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.
Consent form
business associate
Notice of Privacy Practices
privacy
25. 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
consent
complience
premium
26. A structure for classifying outpatient services and procedures for purpose of payment
etiquette
Resonable Charge
(APC) Ambulatory Patient Classifications
cash flow
27. Customs - rules of conduct - courtesy - and manners of the medical profession
Maximum Out Of Pocket
etiquette
Amblatory Care
(UCR) Usual - Customary and Reasonable
28. A monthly fee paid by the insured for specific medical insurance coverage
business associate
Covered Expenses
phantom billing
premium
29. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Privacy officer
(TPA) Third Party Administrator
complience plan
medical foundation
30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
consent
(EPO) Exclusive Provider Organization
Specialist
31. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
hmo
(POS) Point-of Service Plan
confidentiality
etiquette
32. Is a provider who sends the patients for testing or treatment
ppo
phantom billing
referring physician
covered entity
33. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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34. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
Preauthorization
consulting physician
pos
hmo
35. Billing for services not performed
hmo
phantom billing
clearinghouse
econdary Payer
36. A list of the amount to be paid by an insurance company for each procedure service
hmo
privacy
ee schedule
security officer
37. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
health care provider
pcp
preauthorization
Claim
38. 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
ethics
econdary Payer
self-referral
39. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(UR) Utilization review
Deductible
abuse
(PEC) Pre-existing condition
40. 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
(PCP) Primary Care Physician
Deductible
ordering physician
complience
41. Verbal or written agreement that gives approval to some action - situation - or statement.
(PCN) Primary Care Network
(Non-par) Non-Participating Provider
fraud
consent
42. Medical services provided on an outpatient basis
complience plan
Amblatory Care
(ABN) Advance Beneficiary Notice
(UCR) Usual - Customary and Reasonable
43. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
Pre-existing Condition Exclusion
Preauthorization
Supplementary Medical Insurance
(ERISA) Employee Retirement Income Security Act of 1974
44. An organization of provider sites with a contracted relationship that offer services
open panel HMO
Beneficiary
ids
Sub-acute Care
45. 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.
Privacy officer
prepaid plan
Sub-acute Care
phantom billing
46. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Network
fraud
disclosure
Claim
47. 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
Security Rule
fraud
(POS) Point-of Service Plan
(APC) Ambulatory Patient Classifications
48. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Privacy officer
claim
medical foundation
consulting physician
49. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Preauthorization
(Non-par) Non-Participating Provider
phantom billing
50. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Medigap Insurance
Maximum Out Of Pocket
consulting physician
(DOS) Date of Service