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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 independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Maximum Out Of Pocket
econdary Payer
(TPA) Third Party Administrator
hmo
2. Integrating benefits payable under more than one health insurance.
privacy
phantom billing
Sub-acute Care
Coordinated Coverage
3. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
Network
Medigap Insurance
Privileged information
Out of Network (OON)
4. A list of the amount to be paid by an insurance company for each procedure service
(DOS) Date of Service
open panel HMO
Allowed Expenses
ee schedule
5. 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
security officer
referral
authorization form
(COBRA)
6. A privileged communication that may be disclosed only with the patient's permission.
referring physician
Notice of Privacy Practices
Confidential communication
Out of Network (OON)
7. The amount of actual money available to the medical practice
cash flow
clearinghouse
Experimental Procedures
Subscriber
8. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Assignment & Authorization
Coordinated Coverage
deductible
Privacy officer
9. Unauthorized release of information
cash flow
Out of Network (OON)
claim
breach of confidential communication
10. A patient claim is eligible for medicare and medicaid
Participating Provider
Open Enrollment
AMA
crossover claim
11. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Network
state preemption
ordering physician
epo
12. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
transaction
deductible
Standard
Specialist
13. 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
(EPO) Exclusive Provider Organization
transaction
(POS) Point-of Service Plan
phantom billing
14. 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
health care provider
pcp
confidentiality
15. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Amblatory Care
(PAC) Pre- Admission Certification
security officer
(UR) Utilization review
16. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
authorization form
hmo
privacy
(COB) Coordination of Benefits
17. 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
complience
covered entity
prepaid plan
confidentiality
18. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
confidentiality
Maximum Out Of Pocket
(UR) Utilization review
19. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(DME) Durable Medical Equipment
econdary Payer
transaction
(POS) Point-of Service Plan
20. A patient claim is eligible for medicare and medicaid
phantom billing
Assignment & Authorization
crossover claim
etiquette
21. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
(COBRA)
Pre-certification
ppo
Confidential communication
22. 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
Subscriber
hmo
Allowed Expenses
23. The period of time that payment for Medicare inpatient hospital benefits are available
subscriber
(EPO) Exclusive Provider Organization
benefit period
state preemption
24. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Coordinated Coverage
business associate
Treating or performing physician
confidentiality
25. Verbal or written agreement that gives approval to some action - situation - or statement.
(PCP) Primary Care Physician
consent
privacy
Preauthorization
26. 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
Medigap Insurance
clearinghouse
ee schedule
(POS) Point-of Service Plan
27. A monthly fee paid by the insured for specific medical insurance coverage
(PCP) Primary Care Physician
premium
covered entity
HIPAA
28. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
HIPAA
econdary Payer
open panel HMO
claim
29. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
econdary Payer
complience
hmo
ids
30. 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
Embezzlement
Out of Network (OON)
(ERISA) Employee Retirement Income Security Act of 1974
Experimental Procedures
31. American Medical Association
AMA
(TPA) Third Party Administrator
(ERISA) Employee Retirement Income Security Act of 1974
consent
32. An intentional misrepresentation of the facts to deceive or mislead another.
Security Rule
(COBRA)
complience plan
fraud
33. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Out of Network (OON)
pos
referral
ppo
34. A privileged communication that may be disclosed only with the patient's permission.
referring physician
Confidential communication
crossover claim
Pre-existing Condition Exclusion
35. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Resonable Charge
ethics
Specialist
pcp
36. 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
e-health information management
claim
Pre-existing Condition Exclusion
(PCP) Primary Care Physician
37. Data related to the treatment and progress of the patient that can be released only when written authorization of the patient or guardian is obtained.
ethics
Privileged information
Covered Expenses
(Non-par) Non-Participating Provider
38. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Confidential communication
referral
covered entity
claim
39. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
disclosure
referral
ppo
40. What the insurance company will consider paying for as defined in the contract.
cash flow
(ERISA) Employee Retirement Income Security Act of 1974
Covered Expenses
ppo
41. Is a provider who sends the patients for testing or treatment
referring physician
(COB) Coordination of Benefits
Confidential communication
ethics
42. A health insurance enrollee chooses to see an out of network provider without authorization
(PAC) Pre- Admission Certification
(AOB) Assignment of Benefits
self-referral
Embezzlement
43. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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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.
Embezzlement
Privacy officer
ethics
(PCP) Primary Care Physician
45. 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
privacy
Maximum Out Of Pocket
breach of confidential communication
(AOB) Assignment of Benefits
46. The dates of healthcare services were provided to the beneficiary
Confidential communication
(DOS) Date of Service
(PEC) Pre-existing condition
Amblatory Care
47. 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
subscriber
privacy
(PCN) Primary Care Network
Open Enrollment
48. A provision that apples when a person is covered under more than one group medical program
(ERISA) Employee Retirement Income Security Act of 1974
Specialist
(COB) Coordination of Benefits
Embezzlement
49. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
health care provider
pcp
Security Rule
prepaid plan
50. 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
claim
Supplementary Medical Insurance
self-referral
(PCP) Primary Care Physician