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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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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. Medicare's method of paying acute care hospitals for inpatient care
state preemption
Assignment & Authorization
referral
(PPS) Hospital Impatient Prospective Payment System
2. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
etiquette
consent
(PCN) Primary Care Network
3. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
state preemption
Experimental Procedures
Medigap Insurance
Open Enrollment
4. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
Out of Network (OON)
Resonable Charge
econdary Payer
5. 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.
security officer
Participating Provider
HIPAA
(Non-par) Non-Participating Provider
6. A monthly fee paid by the insured for specific medical insurance coverage
consulting physician
Claim
premium
(APC) Ambulatory Patient Classifications
7. A provision that apples when a person is covered under more than one group medical program
covered entity
(AOB) Assignment of Benefits
business associate
(COB) Coordination of Benefits
8. 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
econdary Payer
Treating or performing physician
(PCP) Primary Care Physician
Referral
9. 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
(PCN) Primary Care Network
transaction
(PEC) Pre-existing condition
complience
10. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Preauthorization
premium
abuse
11. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(UR) Utilization review
(COBRA)
disclosure
ids
12. Integrating benefits payable under more than one health insurance.
Assignment & Authorization
epo
Network
Coordinated Coverage
13. Standards of conduct generally accepted as a moral guide for behavior.
preauthorization
referring physician
ethics
Standard
14. 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
ordering physician
Supplementary Medical Insurance
Pre-existing Condition Exclusion
crossover claim
15. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Allowed Expenses
Resonable Charge
ee schedule
business associate
16. The amount of actual money available to the medical practice
cash flow
IIHI
ids
AMA
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. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
subscriber
(DCI) Duplicate Coverage Inquiry
(PEC) Pre-existing condition
HIPAA
19. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
abuse
clearinghouse
Individually identifiable health information
(EPO) Exclusive Provider Organization
20. 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
consent
cash flow
econdary Payer
21. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Amblatory Care
ids
pos
Medigap Insurance
22. What the insurance company will consider paying for as defined in the contract.
(COB) Coordination of Benefits
Covered Expenses
benefit period
Referral
23. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
pcp
Subscriber
abuse
24. 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.
(PEC) Pre-existing condition
complience
Privileged information
AMA
25. Individually identifiable health information
Covered Expenses
attending physician
authorization form
IIHI
26. Individually identifiable health information
Supplementary Medical Insurance
covered entity
(ABN) Advance Beneficiary Notice
IIHI
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.
Preauthorization
(UCR) Usual - Customary and Reasonable
(EPO) Exclusive Provider Organization
Protected health information
28. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(PCN) Primary Care Network
crossover claim
HIPAA
subscriber
29. The dates of healthcare services were provided to the beneficiary
(DCI) Duplicate Coverage Inquiry
Network
crossover claim
(DOS) Date of Service
30. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Notice of Privacy Practices
ethics
complience plan
31. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(COBRA)
(TPA) Third Party Administrator
(APC) Ambulatory Patient Classifications
(DOS) Date of Service
32. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
nonprivileged information
(PCN) Primary Care Network
(DRG's)
33. 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.
Preauthorization
business associate
(PPS) Hospital Impatient Prospective Payment System
claim
34. 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
crossover claim
Protected health information
(DME) Durable Medical Equipment
state preemption
35. Unauthorized release of information
cash flow
breach of confidential communication
Open Enrollment
(PCP) Primary Care Physician
36. 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.
Resonable Charge
complience
(COBRA)
security officer
37. 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
ordering physician
IIHI
(POS) Point-of Service Plan
Out of Network (OON)
38. 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.
(TPA) Third Party Administrator
pos
Privileged information
Embezzlement
39. 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
complience plan
(COBRA)
breach of confidential communication
deductible
40. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(DCI) Duplicate Coverage Inquiry
(ABN) Advance Beneficiary Notice
cash flow
Referral
41. 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
security officer
Open Enrollment
Confidential communication
ee schedule
42. Medical services provided on an outpatient basis
Amblatory Care
crossover claim
etiquette
(POS) Point-of Service Plan
43. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
electronic media
complience plan
ethics
etiquette
44. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Individually identifiable health information
abuse
Supplementary Medical Insurance
45. The period of time that payment for Medicare inpatient hospital benefits are available
benefit period
(PCN) Primary Care Network
Assignment & Authorization
(DCI) Duplicate Coverage Inquiry
46. Verbal or written agreement that gives approval to some action - situation - or statement.
Network
consent
Confidential communication
Treating or performing physician
47. 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
business associate
security officer
(EPO) Exclusive Provider Organization
Assignment & Authorization
48. 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
(COBRA)
ordering physician
(PCN) Primary Care Network
Deductible
49. A nonprofit integrated delivery system
Out of Network (OON)
health care provider
Experimental Procedures
medical foundation
50. 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
abuse
Beneficiary
(DRG's)
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