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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. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
security officer
self-referral
(UCR) Usual - Customary and Reasonable
confidentiality
2. The transmission of information between two parties to carry out financial or administrative activities related to health care.
transaction
covered entity
hmo
security officer
3. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
(PEC) Pre-existing condition
Coordinated Coverage
privacy
4. Health Information Portability and Accountability Act
Privacy officer
HIPAA
medical foundation
security officer
5. 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.
Specialist
Notice of Privacy Practices
econdary Payer
Assignment & Authorization
6. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
consulting physician
Coordinated Coverage
claim
7. A nonprofit integrated delivery system
complience
medical foundation
Privileged information
(DRG's)
8. 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
etiquette
(ABN) Advance Beneficiary Notice
(PEC) Pre-existing condition
open panel HMO
9. Is the provider who renders a service to a patient
Sub-acute Care
Treating or performing physician
electronic media
(COBRA)
10. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Individually identifiable health information
pos
Assignment & Authorization
Pre-certification
11. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(COBRA)
Individually identifiable health information
Maximum Out Of Pocket
consulting physician
12. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Standard
(PAC) Pre- Admission Certification
preauthorization
Subscriber
13. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
Security Rule
hmo
ids
Confidential communication
14. 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
Notice of Privacy Practices
ordering physician
Confidential communication
(ERISA) Employee Retirement Income Security Act of 1974
15. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Covered Expenses
Specialist
(ERISA) Employee Retirement Income Security Act of 1974
(PPS) Hospital Impatient Prospective Payment System
16. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Subscriber
closed panel HMO
claim
17. An intentional misrepresentation of the facts to deceive or mislead another.
(UR) Utilization review
phantom billing
(OOPs) Out of Pocket Costs/Expenses
fraud
18. 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
(DRG's)
phantom billing
crossover claim
19. 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)
(OOPs) Out of Pocket Costs/Expenses
(DOS) Date of Service
Pre-certification
20. 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
(ABN) Advance Beneficiary Notice
Deductible
(PAC) Pre- Admission Certification
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.
Deductible
Privileged information
Assignment & Authorization
ethics
22. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(Non-par) Non-Participating Provider
deductible
fraud
Maximum Out Of Pocket
23. Is the provider who renders a service to a patient
security officer
attending physician
Treating or performing physician
Amblatory Care
24. 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
Standard
fraud
pos
(UR) Utilization review
25. Medical services provided on an outpatient basis
Sub-acute Care
Network
Amblatory Care
referral
26. 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
claim
ppo
Experimental Procedures
Maximum Out Of Pocket
27. What the insurance company will consider paying for as defined in the contract.
IIHI
confidentiality
Covered Expenses
Referral
28. Information consisting of ordinary facts unrelated to the treatment of the patient. The patient's authorization is not required to disclose the data unless the record is in a specialty hospital or in a special service unit of a general hospital - suc
state preemption
Deductible
Open Enrollment
nonprivileged information
29. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
medical foundation
Notice of Privacy Practices
(OOPs) Out of Pocket Costs/Expenses
subscriber
30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Treating or performing physician
(PEC) Pre-existing condition
Privacy officer
preauthorization
31. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Confidential communication
(UR) Utilization review
e-health information management
(AOB) Assignment of Benefits
32. A monthly fee paid by the insured for specific medical insurance coverage
Experimental Procedures
referral
Individually identifiable health information
premium
33. Customs - rules of conduct - courtesy - and manners of the medical profession
e-health information management
referring physician
etiquette
(Non-par) Non-Participating Provider
34. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
clearinghouse
referral
complience plan
35. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Claim
Privacy officer
Consent form
referral
36. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
complience
Out of Network (OON)
(TPA) Third Party Administrator
Medigap Insurance
37. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(APC) Ambulatory Patient Classifications
Network
Consent form
clearinghouse
38. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
(UCR) Usual - Customary and Reasonable
epo
ids
Medigap Insurance
39. Standards of conduct generally accepted as a moral guide for behavior.
(ABN) Advance Beneficiary Notice
(ERISA) Employee Retirement Income Security Act of 1974
ethics
(OOPs) Out of Pocket Costs/Expenses
40. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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41. A clinic that is owned by the HMO and the physicians are employees of the HMO
Assignment & Authorization
closed panel HMO
business associate
subscriber
42. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
ppo
(UR) Utilization review
Medigap Insurance
attending physician
43. A patient claim is eligible for medicare and medicaid
etiquette
benefit period
crossover claim
Individually identifiable health information
44. 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.
(Non-par) Non-Participating Provider
(TPA) Third Party Administrator
state preemption
hmo
45. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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46. 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.
(DCI) Duplicate Coverage Inquiry
Confidential communication
health care provider
electronic media
47. 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
Pre-existing Condition Exclusion
open panel HMO
Coordinated Coverage
(ERISA) Employee Retirement Income Security Act of 1974
48. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
abuse
Standard
preauthorization
(OOPs) Out of Pocket Costs/Expenses
49. Health Information Portability and Accountability Act
Assignment & Authorization
(EPO) Exclusive Provider Organization
HIPAA
subscriber
50. 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
Out of Network (OON)
(COBRA)
Preauthorization
medical foundation