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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. 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
fraud
Pre-existing Condition Exclusion
2. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
ppo
Security Rule
referring physician
(UR) Utilization review
3. Medical services provided on an outpatient basis
Amblatory Care
ee schedule
Preauthorization
Referral
4. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
fraud
Deductible
open panel HMO
referral
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
state preemption
open panel HMO
(COBRA)
(POS) Point-of Service Plan
6. 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
Notice of Privacy Practices
Pre-certification
Amblatory Care
Experimental Procedures
7. Billing for services not performed
Privacy officer
Preauthorization
Referral
phantom billing
8. 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
AMA
breach of confidential communication
Specialist
9. What the insurance company will consider paying for as defined in the contract.
Covered Expenses
(PCN) Primary Care Network
Subscriber
privacy
10. 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
Participating Provider
ee schedule
Open Enrollment
Coordinated Coverage
11. 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
(TPA) Third Party Administrator
covered entity
health care provider
12. American Medical Association
(APC) Ambulatory Patient Classifications
Notice of Privacy Practices
abuse
AMA
13. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
(ERISA) Employee Retirement Income Security Act of 1974
(APC) Ambulatory Patient Classifications
IIHI
14. A clinic that is owned by the HMO and the physicians are employees of the HMO
Consent form
closed panel HMO
Deductible
Maximum Out Of Pocket
15. Standards of conduct generally accepted as a moral guide for behavior.
ethics
(APC) Ambulatory Patient Classifications
epo
HIPAA
16. Someone who is eligible for or receiving benefits under an insurance policy or plan
(PAC) Pre- Admission Certification
subscriber
ppo
Beneficiary
17. 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
(UR) Utilization review
(ERISA) Employee Retirement Income Security Act of 1974
(DME) Durable Medical Equipment
(PCP) Primary Care Physician
18. A rule - condition - or requirement
(OOPs) Out of Pocket Costs/Expenses
(DRG's)
claim
Standard
19. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Sub-acute Care
Amblatory Care
Resonable Charge
(OOPs) Out of Pocket Costs/Expenses
20. 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
referral
disclosure
(POS) Point-of Service Plan
21. Is a provider who sends the patients for testing or treatment
referring physician
(PAC) Pre- Admission Certification
clearinghouse
(DCI) Duplicate Coverage Inquiry
22. 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
(ERISA) Employee Retirement Income Security Act of 1974
(AOB) Assignment of Benefits
Standard
Assignment & Authorization
23. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Specialist
Sub-acute Care
premium
24. 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.
crossover claim
ethics
Confidential communication
security officer
25. 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.
Out of Network (OON)
health care provider
ee schedule
(DOS) Date of Service
26. 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
authorization form
(COBRA)
Out of Network (OON)
abuse
27. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(TPA) Third Party Administrator
electronic media
ordering physician
benefit period
28. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Beneficiary
claim
consent
Medigap Insurance
29. Is a provider who sends the patients for testing or treatment
electronic media
Notice of Privacy Practices
(DCI) Duplicate Coverage Inquiry
referring physician
30. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(PCP) Primary Care Physician
Privacy officer
Subscriber
complience
31. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
Medigap Insurance
pos
econdary Payer
32. A monthly fee paid by the insured for specific medical insurance coverage
disclosure
premium
Individually identifiable health information
privacy
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
medical foundation
(PCN) Primary Care Network
Subscriber
preauthorization
34. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
abuse
claim
clearinghouse
35. 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
(PCN) Primary Care Network
(DRG's)
privacy
(COB) Coordination of Benefits
36. Medicare's method of paying acute care hospitals for inpatient care
Privileged information
Referral
(PPS) Hospital Impatient Prospective Payment System
Open Enrollment
37. A review of the need for inpatient hospital care - completed before the actual admission
Privacy officer
(PAC) Pre- Admission Certification
(POS) Point-of Service Plan
deductible
38. 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)
ids
preauthorization
Privacy officer
Consent form
39. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Maximum Out Of Pocket
transaction
authorization form
(UCR) Usual - Customary and Reasonable
40. Is the provider who renders a service to a patient
Treating or performing physician
(TPA) Third Party Administrator
deductible
Coordinated Coverage
41. Medical staff member who is legally responsible for the care and treatment given to a patient.
attending physician
(AOB) Assignment of Benefits
cash flow
Protected health information
42. An organization of provider sites with a contracted relationship that offer services
ids
authorization form
open panel HMO
clearinghouse
43. 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
(DRG's)
Protected health information
(ERISA) Employee Retirement Income Security Act of 1974
(TPA) Third Party Administrator
44. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Maximum Out Of Pocket
crossover claim
AMA
45. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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46. 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
etiquette
covered entity
Medigap Insurance
clearinghouse
47. The condition of being secluded from the presence or view of others.
ppo
Notice of Privacy Practices
privacy
Consent form
48. A review of the need for inpatient hospital care - completed before the actual admission
closed panel HMO
deductible
confidentiality
(PAC) Pre- Admission Certification
49. 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)
Consent form
preauthorization
Claim
(TPA) Third Party Administrator
50. 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
covered entity
(DME) Durable Medical Equipment
fraud