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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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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. 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
(PCP) Primary Care Physician
pcp
subscriber
Supplementary Medical Insurance
2. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
Individually identifiable health information
(DME) Durable Medical Equipment
epo
3. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
(PCN) Primary Care Network
pos
abuse
4. Individually identifiable health information
(Non-par) Non-Participating Provider
breach of confidential communication
IIHI
(EPO) Exclusive Provider Organization
5. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
abuse
abuse
hmo
Maximum Out Of Pocket
6. 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
hmo
(COB) Coordination of Benefits
authorization form
(APC) Ambulatory Patient Classifications
7. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
security officer
Pre-existing Condition Exclusion
nonprivileged information
claim
8. 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
Participating Provider
deductible
pcp
9. Is the provider who renders a service to a patient
consulting physician
Treating or performing physician
transaction
business associate
10. 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
(ERISA) Employee Retirement Income Security Act of 1974
ppo
(POS) Point-of Service Plan
complience
11. 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
Deductible
phantom billing
prepaid plan
crossover claim
12. 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)
(TPA) Third Party Administrator
Consent form
consent
Out of Network (OON)
13. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Deductible
etiquette
Medigap Insurance
(AOB) Assignment of Benefits
14. 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.
(Non-par) Non-Participating Provider
business associate
disclosure
open panel HMO
15. 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
hmo
ppo
(PPS) Hospital Impatient Prospective Payment System
Claim
16. An organization of provider sites with a contracted relationship that offer services
Security Rule
Covered Expenses
ids
hmo
17. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PCN) Primary Care Network
ids
(PEC) Pre-existing condition
crossover claim
18. 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
Maximum Out Of Pocket
Out of Network (OON)
security officer
Pre-existing Condition Exclusion
19. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Beneficiary
closed panel HMO
Network
Maximum Out Of Pocket
20. Integrating benefits payable under more than one health insurance.
(PCP) Primary Care Physician
health care provider
Coordinated Coverage
Resonable Charge
21. 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
(EPO) Exclusive Provider Organization
covered entity
Open Enrollment
Medigap Insurance
22. 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.
Maximum Out Of Pocket
health care provider
Embezzlement
(AOB) Assignment of Benefits
23. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
consent
disclosure
Pre-certification
Claim
24. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Amblatory Care
authorization form
AMA
25. 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.
state preemption
authorization form
(OOPs) Out of Pocket Costs/Expenses
Security Rule
26. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Privacy officer
medical foundation
e-health information management
(UR) Utilization review
27. 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
epo
(Non-par) Non-Participating Provider
(APC) Ambulatory Patient Classifications
consulting physician
28. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(TPA) Third Party Administrator
Supplementary Medical Insurance
ordering physician
transaction
29. 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
subscriber
consulting physician
Sub-acute Care
Preauthorization
30. Is a provider who sends the patients for testing or treatment
referring physician
Allowed Expenses
(PCN) Primary Care Network
(ERISA) Employee Retirement Income Security Act of 1974
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.
Protected health information
complience plan
cash flow
confidentiality
32. 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.
fraud
benefit period
business associate
state preemption
33. 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
(EPO) Exclusive Provider Organization
(PCN) Primary Care Network
premium
complience plan
34. A monthly fee paid by the insured for specific medical insurance coverage
privacy
Medigap Insurance
benefit period
premium
35. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Subscriber
nonprivileged information
(PPS) Hospital Impatient Prospective Payment System
36. 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
Standard
nonprivileged information
pcp
epo
37. 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
Open Enrollment
nonprivileged information
health care provider
medical foundation
38. 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
econdary Payer
Sub-acute Care
phantom billing
subscriber
39. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
nonprivileged information
Standard
Maximum Out Of Pocket
(UR) Utilization review
40. The maximum amount a plan pays for a covered service
authorization form
breach of confidential communication
Allowed Expenses
Beneficiary
41. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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42. An organization of provider sites with a contracted relationship that offer services
Standard
crossover claim
ids
closed panel HMO
43. 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
(DCI) Duplicate Coverage Inquiry
confidentiality
Privileged information
econdary Payer
44. 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
covered entity
security officer
health care provider
AMA
45. 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
covered entity
(AOB) Assignment of Benefits
(PCP) Primary Care Physician
(UCR) Usual - Customary and Reasonable
46. The period of time that payment for Medicare inpatient hospital benefits are available
Resonable Charge
complience plan
benefit period
epo
47. American Medical Association
(APC) Ambulatory Patient Classifications
(PCP) Primary Care Physician
AMA
state preemption
48. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
preauthorization
claim
fraud
subscriber
49. 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
ids
etiquette
abuse
(DME) Durable Medical Equipment
50. 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
Pre-certification
Protected health information
covered entity
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