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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 rule - condition - or requirement
Coordinated Coverage
crossover claim
Standard
ee schedule
2. 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
covered entity
Covered Expenses
Privacy officer
epo
3. American Medical Association
AMA
(ABN) Advance Beneficiary Notice
deductible
(TPA) Third Party Administrator
4. 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
preauthorization
crossover claim
open panel HMO
(Non-par) Non-Participating 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
premium
epo
(PPS) Hospital Impatient Prospective Payment System
Security Rule
6. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Allowed Expenses
(COBRA)
Amblatory Care
7. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Out of Network (OON)
(COBRA)
(PPS) Hospital Impatient Prospective Payment System
Pre-certification
8. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Deductible
preauthorization
authorization form
complience plan
9. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
hmo
clearinghouse
Security Rule
ordering physician
10. A provision that apples when a person is covered under more than one group medical program
Sub-acute Care
(COB) Coordination of Benefits
(PAC) Pre- Admission Certification
security officer
11. Is the provider who renders a service to a patient
Treating or performing physician
attending physician
ethics
etiquette
12. The period of time that payment for Medicare inpatient hospital benefits are available
(Non-par) Non-Participating Provider
IIHI
benefit period
Standard
13. 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.
referring physician
Subscriber
Subscriber
Protected health information
14. 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
crossover claim
ids
(ERISA) Employee Retirement Income Security Act of 1974
15. 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
(DRG's)
pcp
(POS) Point-of Service Plan
phantom billing
16. Verbal or written agreement that gives approval to some action - situation - or statement.
Claim
(UR) Utilization review
consent
Individually identifiable health information
17. 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
Out of Network (OON)
Pre-certification
Specialist
18. 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
attending physician
state preemption
prepaid plan
Covered Expenses
19. Individually identifiable health information
IIHI
prepaid plan
benefit period
econdary Payer
20. An intentional misrepresentation of the facts to deceive or mislead another.
fraud
authorization form
Specialist
ethics
21. 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.
open panel HMO
business associate
(PAC) Pre- Admission Certification
e-health information management
22. 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
(PEC) Pre-existing condition
Maximum Out Of Pocket
deductible
(DRG's)
23. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
Standard
Maximum Out Of Pocket
AMA
24. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Treating or performing physician
Open Enrollment
Protected health information
ordering physician
25. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
deductible
ethics
referral
confidentiality
26. 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
medical foundation
(PCP) Primary Care Physician
(ABN) Advance Beneficiary Notice
open panel HMO
27. A list of the amount to be paid by an insurance company for each procedure service
confidentiality
(PPS) Hospital Impatient Prospective Payment System
ee schedule
Preauthorization
28. A structure for classifying outpatient services and procedures for purpose of payment
health care provider
(COBRA)
Security Rule
(APC) Ambulatory Patient Classifications
29. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
(APC) Ambulatory Patient Classifications
Covered Expenses
breach of confidential communication
30. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(POS) Point-of Service Plan
Notice of Privacy Practices
complience plan
deductible
31. 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
(ERISA) Employee Retirement Income Security Act of 1974
pos
Security Rule
authorization form
32. 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
premium
Out of Network (OON)
Participating Provider
complience
33. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Pre-existing Condition Exclusion
transaction
hmo
(APC) Ambulatory Patient Classifications
34. 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
(DRG's)
epo
premium
(PCN) Primary Care Network
35. 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
Coordinated Coverage
Supplementary Medical Insurance
Experimental Procedures
Covered Expenses
36. Health Information Portability and Accountability Act
Consent form
deductible
HIPAA
Supplementary Medical Insurance
37. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
ethics
Claim
econdary Payer
covered entity
38. A form signed by the patient showing insurance plans assigned and their billing priority. This form allows the hospital to bill insurance on the patient's behalf and receive payment directly from the payor
Assignment & Authorization
Claim
pcp
transaction
39. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
Privileged information
transaction
referral
40. Is the provider who renders a service to a patient
nonprivileged information
Resonable Charge
Individually identifiable health information
Treating or performing physician
41. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Participating Provider
Subscriber
ee schedule
authorization form
42. Verbal or written agreement that gives approval to some action - situation - or statement.
Notice of Privacy Practices
consent
Protected health information
Embezzlement
43. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
HIPAA
abuse
Claim
ordering physician
44. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
ppo
(TPA) Third Party Administrator
subscriber
Participating Provider
45. 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.
Pre-existing Condition Exclusion
Treating or performing physician
Privacy officer
(COBRA)
46. A patient claim is eligible for medicare and medicaid
confidentiality
prepaid plan
crossover claim
Covered Expenses
47. 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
self-referral
Privileged information
attending physician
Preauthorization
48. Under HIPAA - a document given to the patient at the first visit or at enrollment explaining the individual's rights and the physician's legal duties in regard to protected health information.
Notice of Privacy Practices
open panel HMO
confidentiality
(UR) Utilization review
49. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Pre-certification
hmo
e-health information management
Specialist
50. 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
Open Enrollment
(DOS) Date of Service
Security Rule
Privileged information