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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 clinic that is owned by the HMO and the physicians are employees of the HMO
ee schedule
ppo
(PCN) Primary Care Network
closed panel HMO
2. 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
authorization form
Protected health information
(ERISA) Employee Retirement Income Security Act of 1974
pos
3. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(PCN) Primary Care Network
subscriber
Embezzlement
cash flow
4. 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
(COBRA)
security officer
Open Enrollment
health care provider
5. 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
hmo
econdary Payer
Treating or performing physician
epo
6. Medical staff member who is legally responsible for the care and treatment given to a patient.
Coordinated Coverage
Amblatory Care
(POS) Point-of Service Plan
attending physician
7. A flexible health care plan that allows patients to choose using the panel of providers within the HMO network or to utilize the services of non HMO providers
closed panel HMO
Individually identifiable health information
pos
crossover claim
8. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
covered entity
ppo
(ABN) Advance Beneficiary Notice
9. Individually identifiable health information
IIHI
(ERISA) Employee Retirement Income Security Act of 1974
business associate
hmo
10. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
Amblatory Care
Coordinated Coverage
(PEC) Pre-existing condition
11. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
Pre-existing Condition Exclusion
crossover claim
Pre-certification
12. Integrating benefits payable under more than one health insurance.
pcp
Sub-acute Care
Coordinated Coverage
Deductible
13. 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
AMA
etiquette
Participating Provider
Claim
14. The condition of being secluded from the presence or view of others.
hmo
privacy
breach of confidential communication
claim
15. The dates of healthcare services were provided to the beneficiary
Experimental Procedures
(DOS) Date of Service
Coordinated Coverage
Treating or performing physician
16. Approval or consent by a primary physician for patient referral to ancillary services and specialists
self-referral
Deductible
Referral
cash flow
17. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(PCN) Primary Care Network
(EPO) Exclusive Provider Organization
Medigap Insurance
(APC) Ambulatory Patient Classifications
18. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Out of Network (OON)
(PAC) Pre- Admission Certification
Medigap Insurance
Supplementary Medical Insurance
19. 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
pos
(DME) Durable Medical Equipment
epo
20. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
open panel HMO
closed panel HMO
Deductible
disclosure
21. 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
Beneficiary
prepaid plan
referral
AMA
22. 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.
benefit period
security officer
Network
consulting physician
23. 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
(AOB) Assignment of Benefits
hmo
IIHI
business associate
24. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
econdary Payer
medical foundation
transaction
25. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
covered entity
epo
crossover claim
subscriber
26. 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
medical foundation
econdary Payer
Sub-acute Care
Allowed Expenses
27. A health insurance enrollee chooses to see an out of network provider without authorization
(TPA) Third Party Administrator
self-referral
e-health information management
(EPO) Exclusive Provider Organization
28. A health care provider that is not employed by the HMO and does not belong to a medical group owned or managed by the HMO
pcp
open panel HMO
Protected health information
claim
29. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
(PAC) Pre- Admission Certification
subscriber
Out of Network (OON)
30. 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.
Medigap Insurance
Privileged information
transaction
Security Rule
31. Verbal or written agreement that gives approval to some action - situation - or statement.
consent
econdary Payer
Subscriber
Medigap Insurance
32. 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
disclosure
Privileged information
Security Rule
Sub-acute Care
33. 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
Open Enrollment
(DME) Durable Medical Equipment
crossover claim
nonprivileged information
34. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(AOB) Assignment of Benefits
Deductible
consulting physician
(DME) Durable Medical Equipment
35. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
pcp
covered entity
(ERISA) Employee Retirement Income Security Act of 1974
claim
36. 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
(PEC) Pre-existing condition
Out of Network (OON)
Preauthorization
prepaid plan
37. 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
Consent form
cash flow
Security Rule
Pre-existing Condition Exclusion
38. Unauthorized release of information
claim
Supplementary Medical Insurance
breach of confidential communication
Beneficiary
39. The amount of actual money available to the medical practice
Open Enrollment
cash flow
Network
Out of Network (OON)
40. Standards of conduct generally accepted as a moral guide for behavior.
self-referral
Deductible
ethics
epo
41. A patient claim is eligible for medicare and medicaid
Privileged information
complience
crossover claim
Standard
42. 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
medical foundation
breach of confidential communication
prepaid plan
Privacy officer
43. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Specialist
Pre-certification
(PCP) Primary Care Physician
prepaid plan
44. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(APC) Ambulatory Patient Classifications
Claim
IIHI
complience plan
45. 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
(PAC) Pre- Admission Certification
authorization form
Sub-acute Care
phantom billing
46. A patient claim is eligible for medicare and medicaid
crossover claim
complience plan
Privacy officer
Covered Expenses
47. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
consent
electronic media
crossover claim
(DCI) Duplicate Coverage Inquiry
48. 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
epo
Medigap Insurance
Out of Network (OON)
Maximum Out Of Pocket
49. Unauthorized release of information
breach of confidential communication
(PEC) Pre-existing condition
business associate
benefit period
50. 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
Privileged information
(DRG's)
Amblatory Care