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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. 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.
Supplementary Medical Insurance
Notice of Privacy Practices
etiquette
Sub-acute Care
2. Standards of conduct generally accepted as a moral guide for behavior.
AMA
(AOB) Assignment of Benefits
ethics
medical foundation
3. 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
authorization form
IIHI
(PCN) Primary Care Network
(PCN) Primary Care Network
4. 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
(POS) Point-of Service Plan
Consent form
(PCN) Primary Care Network
Treating or performing physician
5. What the insurance company will consider paying for as defined in the contract.
deductible
Covered Expenses
Medigap Insurance
Individually identifiable health information
6. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
ids
Coordinated Coverage
(PCP) Primary Care Physician
7. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
(ERISA) Employee Retirement Income Security Act of 1974
Maximum Out Of Pocket
ppo
Network
8. 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
(COBRA)
covered entity
Covered Expenses
Participating Provider
9. 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
(AOB) Assignment of Benefits
epo
complience
crossover claim
10. Medical services provided on an outpatient basis
(DOS) Date of Service
Coordinated Coverage
Amblatory Care
privacy
11. 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
Consent form
(AOB) Assignment of Benefits
(Non-par) Non-Participating Provider
privacy
12. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(OOPs) Out of Pocket Costs/Expenses
phantom billing
transaction
crossover claim
13. A review of the need for inpatient hospital care - completed before the actual admission
ordering physician
self-referral
(PAC) Pre- Admission Certification
ppo
14. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(COBRA)
(UCR) Usual - Customary and Reasonable
Assignment & Authorization
hmo
15. A review of the need for inpatient hospital care - completed before the actual admission
(PEC) Pre-existing condition
(PAC) Pre- Admission Certification
ee schedule
(APC) Ambulatory Patient Classifications
16. Customs - rules of conduct - courtesy - and manners of the medical profession
complience plan
econdary Payer
etiquette
privacy
17. Verbal or written agreement that gives approval to some action - situation - or statement.
econdary Payer
consent
Notice of Privacy Practices
premium
18. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(DOS) Date of Service
Claim
HIPAA
(EPO) Exclusive Provider Organization
19. The amount of actual money available to the medical practice
complience
Network
Protected health information
cash flow
20. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
econdary Payer
(PEC) Pre-existing condition
Maximum Out Of Pocket
benefit period
21. 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)
Notice of Privacy Practices
Resonable Charge
Confidential communication
Consent form
22. 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
referring physician
prepaid plan
attending physician
Assignment & Authorization
23. The maximum amount a plan pays for a covered service
Consent form
ee schedule
Allowed Expenses
Claim
24. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Consent form
Claim
ids
consulting physician
25. 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
(DME) Durable Medical Equipment
abuse
Supplementary Medical Insurance
(Non-par) Non-Participating Provider
26. Someone who is eligible for or receiving benefits under an insurance policy or plan
(COB) Coordination of Benefits
Beneficiary
(DCI) Duplicate Coverage Inquiry
HIPAA
27. 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
ee schedule
Sub-acute Care
(POS) Point-of Service Plan
28. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
Claim
Out of Network (OON)
fraud
29. Integrating benefits payable under more than one health insurance.
(ABN) Advance Beneficiary Notice
consulting physician
Coordinated Coverage
state preemption
30. 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.
covered entity
Privacy officer
Covered Expenses
pcp
31. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
breach of confidential communication
complience
state preemption
32. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
transaction
open panel HMO
(PCN) Primary Care Network
clearinghouse
33. 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
Amblatory Care
(UCR) Usual - Customary and Reasonable
open panel HMO
(POS) Point-of Service Plan
34. A rule - condition - or requirement
(OOPs) Out of Pocket Costs/Expenses
Standard
abuse
Supplementary Medical Insurance
35. 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.
(UCR) Usual - Customary and Reasonable
security officer
Covered Expenses
(EPO) Exclusive Provider Organization
36. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Treating or performing physician
referral
consulting physician
etiquette
37. A clinic that is owned by the HMO and the physicians are employees of the HMO
fraud
self-referral
closed panel HMO
Referral
38. American Medical Association
Sub-acute Care
self-referral
confidentiality
AMA
39. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
crossover claim
phantom billing
(PCN) Primary Care Network
Network
40. 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
Open Enrollment
(DOS) Date of Service
(PEC) Pre-existing condition
medical foundation
41. Unauthorized release of information
Covered Expenses
breach of confidential communication
complience
(TPA) Third Party Administrator
42. 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
deductible
(OOPs) Out of Pocket Costs/Expenses
transaction
(ABN) Advance Beneficiary Notice
43. 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
closed panel HMO
preauthorization
(COBRA)
Notice of Privacy Practices
44. Approval or consent by a primary physician for patient referral to ancillary services and specialists
(PEC) Pre-existing condition
(COB) Coordination of Benefits
(OOPs) Out of Pocket Costs/Expenses
Referral
45. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Privacy officer
phantom billing
(COBRA)
(UR) Utilization review
46. A monthly fee paid by the insured for specific medical insurance coverage
(Non-par) Non-Participating Provider
premium
ee schedule
epo
47. A privileged communication that may be disclosed only with the patient's permission.
(DCI) Duplicate Coverage Inquiry
Confidential communication
medical foundation
medical foundation
48. 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
authorization form
prepaid plan
Notice of Privacy Practices
Pre-existing Condition Exclusion
49. 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
covered entity
Maximum Out Of Pocket
(OOPs) Out of Pocket Costs/Expenses
etiquette
50. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Resonable Charge
(PAC) Pre- Admission Certification
Beneficiary
disclosure