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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. 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.
(UCR) Usual - Customary and Reasonable
Privacy officer
Preauthorization
authorization form
2. 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.
(DME) Durable Medical Equipment
state preemption
(PCP) Primary Care Physician
(DCI) Duplicate Coverage Inquiry
3. Medicare's method of paying acute care hospitals for inpatient care
claim
(PPS) Hospital Impatient Prospective Payment System
preauthorization
Maximum Out Of Pocket
4. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
ethics
Network
complience plan
5. A rule - condition - or requirement
Standard
epo
benefit period
medical foundation
6. An intentional misrepresentation of the facts to deceive or mislead another.
Experimental Procedures
(DME) Durable Medical Equipment
fraud
Specialist
7. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
pos
transaction
econdary Payer
subscriber
8. 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
(POS) Point-of Service Plan
epo
Specialist
IIHI
9. 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
Coordinated Coverage
phantom billing
econdary Payer
(DRG's)
10. 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
clearinghouse
Pre-existing Condition Exclusion
(COB) Coordination of Benefits
Allowed Expenses
11. 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
(Non-par) Non-Participating Provider
Pre-existing Condition Exclusion
(DCI) Duplicate Coverage Inquiry
econdary Payer
12. A clinic that is owned by the HMO and the physicians are employees of the HMO
phantom billing
closed panel HMO
security officer
Coordinated Coverage
13. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
e-health information management
abuse
econdary Payer
14. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(EPO) Exclusive Provider Organization
Assignment & Authorization
(PCP) Primary Care Physician
Resonable Charge
15. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
electronic media
confidentiality
(DCI) Duplicate Coverage Inquiry
econdary Payer
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
Privacy officer
(OOPs) Out of Pocket Costs/Expenses
Subscriber
Open Enrollment
17. 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.
Protected health information
health care provider
Referral
deductible
18. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Participating Provider
claim
ordering physician
ordering physician
19. 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
(POS) Point-of Service Plan
Standard
covered entity
Privacy officer
20. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Medigap Insurance
econdary Payer
consulting physician
(UR) Utilization review
21. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Claim
Coordinated Coverage
Consent form
22. A structure for classifying outpatient services and procedures for purpose of payment
covered entity
Experimental Procedures
health care provider
(APC) Ambulatory Patient Classifications
23. Customs - rules of conduct - courtesy - and manners of the medical profession
etiquette
health care provider
(DRG's)
HIPAA
24. 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
fraud
Out of Network (OON)
ee schedule
Notice of Privacy Practices
25. The condition of being secluded from the presence or view of others.
electronic media
Amblatory Care
privacy
Assignment & Authorization
26. 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
breach of confidential communication
deductible
(DCI) Duplicate Coverage Inquiry
27. 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
Resonable Charge
(PCN) Primary Care Network
IIHI
Amblatory Care
28. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
IIHI
Coordinated Coverage
ee schedule
29. 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
complience plan
Out of Network (OON)
Medigap Insurance
(ERISA) Employee Retirement Income Security Act of 1974
30. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(PPS) Hospital Impatient Prospective Payment System
Pre-existing Condition Exclusion
preauthorization
(EPO) Exclusive Provider Organization
31. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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32. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Out of Network (OON)
transaction
Subscriber
premium
33. 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.
ids
Assignment & Authorization
security officer
Open Enrollment
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
Consent form
Sub-acute Care
consulting physician
Preauthorization
35. Standards of conduct generally accepted as a moral guide for behavior.
Covered Expenses
Individually identifiable health information
ethics
claim
36. 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
self-referral
(PAC) Pre- Admission Certification
Participating Provider
Open Enrollment
37. Is a provider who sends the patients for testing or treatment
medical foundation
(EPO) Exclusive Provider Organization
referring physician
Maximum Out Of Pocket
38. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
ordering physician
consulting physician
cash flow
electronic media
39. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
disclosure
Maximum Out Of Pocket
Pre-certification
40. A willful act by an employee of taking possession of an employer's money
Embezzlement
health care provider
(PAC) Pre- Admission Certification
subscriber
41. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
privacy
deductible
Medigap Insurance
(UR) Utilization review
42. Someone who is eligible for or receiving benefits under an insurance policy or plan
(PPS) Hospital Impatient Prospective Payment System
Beneficiary
(APC) Ambulatory Patient Classifications
Treating or performing physician
43. 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
Experimental Procedures
Out of Network (OON)
(DCI) Duplicate Coverage Inquiry
Privileged information
44. 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.
(PAC) Pre- Admission Certification
referring physician
Privacy officer
(DRG's)
45. Is a provider who sends the patients for testing or treatment
confidentiality
referring physician
claim
closed panel HMO
46. 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
complience plan
Deductible
referring physician
business associate
47. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Consent form
pcp
(PPS) Hospital Impatient Prospective Payment System
security officer
48. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(AOB) Assignment of Benefits
Claim
Coordinated Coverage
abuse
49. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(TPA) Third Party Administrator
state preemption
Preauthorization
50. Individually identifiable health information
Consent form
pcp
IIHI
Confidential communication