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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.
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study here
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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. An organization of provider sites with a contracted relationship that offer services
ids
Allowed Expenses
(COBRA)
preauthorization
2. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
(POS) Point-of Service Plan
Consent form
crossover claim
abuse
3. A nonprofit integrated delivery system
authorization form
(PPS) Hospital Impatient Prospective Payment System
referral
medical foundation
4. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
clearinghouse
(PPS) Hospital Impatient Prospective Payment System
(UR) Utilization review
(Non-par) Non-Participating Provider
5. 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
state preemption
(UCR) Usual - Customary and Reasonable
benefit period
6. 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
Standard
Notice of Privacy Practices
Amblatory Care
Assignment & Authorization
7. 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
Supplementary Medical Insurance
Maximum Out Of Pocket
preauthorization
Covered Expenses
8. 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
(DME) Durable Medical Equipment
security officer
Subscriber
Out of Network (OON)
9. 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
Assignment & Authorization
e-health information management
(DME) Durable Medical Equipment
Consent form
10. 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.
confidentiality
Protected health information
IIHI
(APC) Ambulatory Patient Classifications
11. 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
prepaid plan
covered entity
Assignment & Authorization
open panel HMO
12. Billing for services not performed
phantom billing
HIPAA
transaction
ids
13. The maximum amount a plan pays for a covered service
claim
abuse
Allowed Expenses
deductible
14. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Specialist
complience plan
Security Rule
Amblatory Care
15. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
e-health information management
ethics
consulting physician
subscriber
16. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
disclosure
Resonable Charge
Sub-acute Care
ordering physician
17. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Security Rule
(POS) Point-of Service Plan
Experimental Procedures
(UR) Utilization review
18. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
(DME) Durable Medical Equipment
authorization form
subscriber
19. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
hmo
self-referral
electronic media
(DCI) Duplicate Coverage Inquiry
20. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
ids
(UCR) Usual - Customary and Reasonable
(EPO) Exclusive Provider Organization
subscriber
21. 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
referral
Consent form
Resonable Charge
ppo
22. The transmission of information between two parties to carry out financial or administrative activities related to health care.
ppo
ordering physician
(OOPs) Out of Pocket Costs/Expenses
transaction
23. 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
e-health information management
(COBRA)
Standard
Experimental Procedures
24. Is a provider who sends the patients for testing or treatment
referring physician
(PAC) Pre- Admission Certification
ids
e-health information management
25. Medicare's method of paying acute care hospitals for inpatient care
complience plan
state preemption
nonprivileged information
(PPS) Hospital Impatient Prospective Payment System
26. 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
(EPO) Exclusive Provider Organization
(PCN) Primary Care Network
IIHI
Preauthorization
27. 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
fraud
premium
state preemption
28. A willful act by an employee of taking possession of an employer's money
Embezzlement
disclosure
Pre-existing Condition Exclusion
Open Enrollment
29. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Allowed Expenses
IIHI
Network
Medigap Insurance
30. 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
Sub-acute Care
Medigap Insurance
security officer
breach of confidential communication
31. Verbal or written agreement that gives approval to some action - situation - or statement.
medical foundation
deductible
attending physician
consent
32. The dates of healthcare services were provided to the beneficiary
self-referral
(DOS) Date of Service
HIPAA
Sub-acute Care
33. 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
Individually identifiable health information
(UCR) Usual - Customary and Reasonable
covered entity
(TPA) Third Party Administrator
34. The condition of being secluded from the presence or view of others.
self-referral
subscriber
Beneficiary
privacy
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.
referral
referring physician
Participating Provider
business associate
36. American Medical Association
AMA
Out of Network (OON)
(APC) Ambulatory Patient Classifications
(COB) Coordination of Benefits
37. 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
Consent form
ppo
Individually identifiable health information
38. 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
self-referral
(POS) Point-of Service Plan
phantom billing
(PEC) Pre-existing condition
39. 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
Pre-existing Condition Exclusion
(DRG's)
referral
Open Enrollment
40. A health insurance enrollee chooses to see an out of network provider without authorization
Individually identifiable health information
(DRG's)
(DCI) Duplicate Coverage Inquiry
self-referral
41. A monthly fee paid by the insured for specific medical insurance coverage
Maximum Out Of Pocket
(Non-par) Non-Participating Provider
ethics
premium
42. 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
econdary Payer
Consent form
Open Enrollment
hmo
43. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(TPA) Third Party Administrator
(ERISA) Employee Retirement Income Security Act of 1974
(UCR) Usual - Customary and Reasonable
Privacy officer
44. 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
(DCI) Duplicate Coverage Inquiry
medical foundation
authorization form
Beneficiary
45. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Maximum Out Of Pocket
(COB) Coordination of Benefits
(EPO) Exclusive Provider Organization
Claim
46. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
business associate
claim
cash flow
47. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(AOB) Assignment of Benefits
business associate
(OOPs) Out of Pocket Costs/Expenses
hmo
48. 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
(OOPs) Out of Pocket Costs/Expenses
nonprivileged information
clearinghouse
49. 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
premium
Consent form
pos
Coordinated Coverage
50. The amount of actual money available to the medical practice
prepaid plan
(PEC) Pre-existing condition
Subscriber
cash flow