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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.
privacy
fraud
abuse
(PPS) Hospital Impatient Prospective Payment System
2. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
(PCP) Primary Care Physician
referral
Notice of Privacy Practices
3. 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
Participating Provider
Claim
Security Rule
complience plan
4. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
deductible
complience
Pre-certification
Open Enrollment
5. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(OOPs) Out of Pocket Costs/Expenses
(PCN) Primary Care Network
econdary Payer
claim
6. 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
(DRG's)
authorization form
Claim
Deductible
7. 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
(PEC) Pre-existing condition
Specialist
Pre-existing Condition Exclusion
benefit period
8. A list of the amount to be paid by an insurance company for each procedure service
econdary Payer
(APC) Ambulatory Patient Classifications
(COBRA)
ee schedule
9. 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
Individually identifiable health information
(POS) Point-of Service Plan
Sub-acute Care
(EPO) Exclusive Provider Organization
10. The amount of actual money available to the medical practice
cash flow
claim
(APC) Ambulatory Patient Classifications
transaction
11. Is a provider who sends the patients for testing or treatment
(PCP) Primary Care Physician
Network
referring physician
(PPS) Hospital Impatient Prospective Payment System
12. 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
pos
ordering physician
Standard
Protected health information
13. 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
(TPA) Third Party Administrator
Confidential communication
AMA
14. 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
Privacy officer
privacy
(COBRA)
Confidential communication
15. Integrating benefits payable under more than one health insurance.
Medigap Insurance
Protected health information
Coordinated Coverage
(UR) Utilization review
16. 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
Deductible
(DOS) Date of Service
preauthorization
IIHI
17. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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18. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Embezzlement
consent
Preauthorization
Medigap Insurance
19. Unauthorized release of information
ids
breach of confidential communication
covered entity
Claim
20. 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
Covered Expenses
(AOB) Assignment of Benefits
electronic media
Preauthorization
21. 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.
Privileged information
Pre-existing Condition Exclusion
Participating Provider
(DCI) Duplicate Coverage Inquiry
22. An intentional misrepresentation of the facts to deceive or mislead another.
ee schedule
disclosure
fraud
etiquette
23. 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
(OOPs) Out of Pocket Costs/Expenses
etiquette
referring physician
Deductible
24. 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
benefit period
(DCI) Duplicate Coverage Inquiry
Sub-acute Care
Protected health information
25. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
Open Enrollment
consent
state preemption
26. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Deductible
authorization form
(UR) Utilization review
Assignment & Authorization
27. 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.
fraud
Protected health information
(DCI) Duplicate Coverage Inquiry
cash flow
28. The condition of being secluded from the presence or view of others.
Out of Network (OON)
Treating or performing physician
privacy
confidentiality
29. 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
Referral
(DCI) Duplicate Coverage Inquiry
Experimental Procedures
open panel HMO
30. Someone who is eligible for or receiving benefits under an insurance policy or plan
crossover claim
(PCP) Primary Care Physician
ids
Beneficiary
31. 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
(DOS) Date of Service
Supplementary Medical Insurance
Network
ethics
32. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
referral
(COB) Coordination of Benefits
complience
(DCI) Duplicate Coverage Inquiry
33. Individually identifiable health information
Maximum Out Of Pocket
(EPO) Exclusive Provider Organization
etiquette
IIHI
34. A provision that apples when a person is covered under more than one group medical program
e-health information management
(PPS) Hospital Impatient Prospective Payment System
(TPA) Third Party Administrator
(COB) Coordination of Benefits
35. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
electronic media
subscriber
referral
Open Enrollment
36. Standards of conduct generally accepted as a moral guide for behavior.
benefit period
privacy
preauthorization
ethics
37. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
business associate
Preauthorization
attending physician
38. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
ids
deductible
(EPO) Exclusive Provider Organization
Out of Network (OON)
39. A list of the amount to be paid by an insurance company for each procedure service
Out of Network (OON)
Resonable Charge
ee schedule
self-referral
40. A health care plan that stipulates that the patient must use a medical provider who is under contract with the insurer for an agreed on fee
Standard
ids
fraud
ppo
41. The transmission of information between two parties to carry out financial or administrative activities related to health care.
pos
privacy
crossover claim
transaction
42. 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
phantom billing
clearinghouse
Sub-acute Care
pcp
43. Health Information Portability and Accountability Act
IIHI
HIPAA
self-referral
(UCR) Usual - Customary and Reasonable
44. 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
complience plan
prepaid plan
electronic media
Assignment & Authorization
45. 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
Referral
econdary Payer
claim
security officer
46. The period of time that payment for Medicare inpatient hospital benefits are available
referral
benefit period
premium
Out of Network (OON)
47. Customs - rules of conduct - courtesy - and manners of the medical profession
hmo
HIPAA
Protected health information
etiquette
48. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
complience plan
(UCR) Usual - Customary and Reasonable
Amblatory Care
49. A rule - condition - or requirement
Standard
confidentiality
(OOPs) Out of Pocket Costs/Expenses
claim
50. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
cash flow
(EPO) Exclusive Provider Organization
transaction
(DOS) Date of Service