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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. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Notice of Privacy Practices
abuse
complience plan
Individually identifiable health information
2. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Beneficiary
e-health information management
referral
(TPA) Third Party Administrator
3. 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)
state preemption
Consent form
nonprivileged information
Amblatory Care
4. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Individually identifiable health information
security officer
confidentiality
Subscriber
5. A monthly fee paid by the insured for specific medical insurance coverage
subscriber
premium
(ERISA) Employee Retirement Income Security Act of 1974
(AOB) Assignment of Benefits
6. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
(ABN) Advance Beneficiary Notice
electronic media
Network
7. The amount of actual money available to the medical practice
Open Enrollment
cash flow
open panel HMO
breach of confidential communication
8. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
security officer
authorization form
fraud
9. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
cash flow
complience plan
Amblatory Care
10. 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
(DRG's)
Standard
(PCP) Primary Care Physician
benefit period
11. A privileged communication that may be disclosed only with the patient's permission.
Experimental Procedures
Confidential communication
epo
deductible
12. 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
Referral
Resonable Charge
Assignment & Authorization
13. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
Deductible
(OOPs) Out of Pocket Costs/Expenses
Preauthorization
Security Rule
14. 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
clearinghouse
authorization form
Allowed Expenses
(DCI) Duplicate Coverage Inquiry
15. A list of the amount to be paid by an insurance company for each procedure service
Medigap Insurance
Privacy officer
ee schedule
Preauthorization
16. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
ordering physician
covered entity
Participating Provider
17. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
Assignment & Authorization
HIPAA
referral
18. 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
referral
Security Rule
(AOB) Assignment of Benefits
19. 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
Security Rule
Experimental Procedures
complience plan
Amblatory Care
20. 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
(DCI) Duplicate Coverage Inquiry
nonprivileged information
hmo
(COBRA)
21. What the insurance company will consider paying for as defined in the contract.
consent
Covered Expenses
state preemption
phantom billing
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.
Allowed Expenses
(DCI) Duplicate Coverage Inquiry
Privacy officer
health care provider
23. 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
business associate
closed panel HMO
premium
(PCN) Primary Care Network
24. A health insurance enrollee chooses to see an out of network provider without authorization
Amblatory Care
self-referral
Deductible
Privileged information
25. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
confidentiality
Protected health information
state preemption
(PEC) Pre-existing condition
26. 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
Medigap Insurance
Open Enrollment
Network
Maximum Out Of Pocket
27. 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
Out of Network (OON)
(PCN) Primary Care Network
health care provider
28. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
phantom billing
claim
referring physician
Coordinated Coverage
29. ABN billing rules permit physicians and other Part B care providers to bill beneficiaries directly when Medicare will not cover services for lack of medical necessity
(ABN) Advance Beneficiary Notice
econdary Payer
claim
consulting physician
30. 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
(ERISA) Employee Retirement Income Security Act of 1974
referring physician
complience
Medigap Insurance
31. An intentional misrepresentation of the facts to deceive or mislead another.
Pre-certification
Protected health information
fraud
pos
32. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
fraud
Open Enrollment
Assignment & Authorization
33. Health Information Portability and Accountability Act
security officer
Allowed Expenses
HIPAA
(COB) Coordination of Benefits
34. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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35. 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.
business associate
self-referral
premium
Claim
36. A rule - condition - or requirement
Standard
phantom billing
business associate
clearinghouse
37. An organization of provider sites with a contracted relationship that offer services
(POS) Point-of Service Plan
econdary Payer
ids
confidentiality
38. The maximum amount a plan pays for a covered service
econdary Payer
Allowed Expenses
ee schedule
Maximum Out Of Pocket
39. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
consulting physician
electronic media
(OOPs) Out of Pocket Costs/Expenses
Subscriber
40. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
(DCI) Duplicate Coverage Inquiry
medical foundation
(DCI) Duplicate Coverage Inquiry
41. 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
cash flow
Confidential communication
Deductible
covered entity
42. 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.
health care provider
Experimental Procedures
(UR) Utilization review
pcp
43. 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
Pre-certification
medical foundation
Consent form
44. Customs - rules of conduct - courtesy - and manners of the medical profession
closed panel HMO
privacy
etiquette
Pre-certification
45. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
breach of confidential communication
Security Rule
Specialist
Participating Provider
46. 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
Maximum Out Of Pocket
fraud
Resonable Charge
(PCN) Primary Care Network
47. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Out of Network (OON)
Experimental Procedures
transaction
(ABN) Advance Beneficiary Notice
48. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
e-health information management
pos
Claim
Pre-certification
49. A provision that apples when a person is covered under more than one group medical program
state preemption
confidentiality
Assignment & Authorization
(COB) Coordination of Benefits
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
Notice of Privacy Practices
(PCP) Primary Care Physician
deductible