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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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2. 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.
ethics
Privileged information
premium
(ABN) Advance Beneficiary Notice
3. 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
Sub-acute Care
Individually identifiable health information
Network
Supplementary Medical Insurance
4. 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)
ethics
Deductible
subscriber
Consent form
5. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
pcp
privacy
business associate
Out of Network (OON)
6. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
phantom billing
medical foundation
claim
ethics
7. Medicare's method of paying acute care hospitals for inpatient care
clearinghouse
Coordinated Coverage
(PPS) Hospital Impatient Prospective Payment System
referral
8. Standards of conduct generally accepted as a moral guide for behavior.
ppo
Supplementary Medical Insurance
ethics
Covered Expenses
9. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
(Non-par) Non-Participating Provider
(OOPs) Out of Pocket Costs/Expenses
disclosure
preauthorization
10. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
Network
Out of Network (OON)
Consent form
11. Individually identifiable health information
(PCN) Primary Care Network
IIHI
ee schedule
self-referral
12. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(TPA) Third Party Administrator
Protected health information
Resonable Charge
(DOS) Date of Service
13. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Specialist
phantom billing
(COB) Coordination of Benefits
14. The transmission of information between two parties to carry out financial or administrative activities related to health care.
Covered Expenses
(DME) Durable Medical Equipment
transaction
self-referral
15. 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
e-health information management
Sub-acute Care
prepaid plan
ee schedule
16. A list of the amount to be paid by an insurance company for each procedure service
Deductible
Assignment & Authorization
ee schedule
Embezzlement
17. The amount of actual money available to the medical practice
Pre-existing Condition Exclusion
cash flow
(Non-par) Non-Participating Provider
Coordinated Coverage
18. 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
Medigap Insurance
Treating or performing physician
Referral
pos
19. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Embezzlement
(DCI) Duplicate Coverage Inquiry
(PCP) Primary Care Physician
Claim
20. Billing for services not performed
state preemption
phantom billing
abuse
Security Rule
21. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
ids
(ERISA) Employee Retirement Income Security Act of 1974
crossover claim
Medigap Insurance
22. American Medical Association
Assignment & Authorization
AMA
(UCR) Usual - Customary and Reasonable
crossover claim
23. 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
ppo
epo
privacy
hmo
24. Is the provider who renders a service to a patient
deductible
Subscriber
Treating or performing physician
complience
25. 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
Maximum Out Of Pocket
open panel HMO
(DRG's)
state preemption
26. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Security Rule
Privileged information
consulting physician
Deductible
27. The dates of healthcare services were provided to the beneficiary
confidentiality
referring physician
(DOS) Date of Service
authorization form
28. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Preauthorization
(OOPs) Out of Pocket Costs/Expenses
(ABN) Advance Beneficiary Notice
(DCI) Duplicate Coverage Inquiry
29. 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
breach of confidential communication
ids
pcp
30. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Medigap Insurance
abuse
referral
Claim
31. 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.
Confidential communication
pos
deductible
health care provider
32. A structure for classifying outpatient services and procedures for purpose of payment
Pre-certification
(APC) Ambulatory Patient Classifications
pcp
Embezzlement
33. 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.
Notice of Privacy Practices
security officer
closed panel HMO
Amblatory Care
34. 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.
abuse
(PCP) Primary Care Physician
Pre-existing Condition Exclusion
business associate
35. 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.
Privacy officer
Medigap Insurance
Consent form
IIHI
36. Integrating benefits payable under more than one health insurance.
Resonable Charge
business associate
Coordinated Coverage
nonprivileged information
37. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Participating Provider
Covered Expenses
crossover claim
Claim
38. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
Claim
e-health information management
Treating or performing physician
Privileged information
39. Is the provider who renders a service to a patient
Treating or performing physician
Pre-existing Condition Exclusion
disclosure
privacy
40. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
breach of confidential communication
claim
(PCN) Primary Care Network
subscriber
41. 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.
clearinghouse
closed panel HMO
Notice of Privacy Practices
Consent form
42. Someone who is eligible for or receiving benefits under an insurance policy or plan
complience plan
Beneficiary
clearinghouse
(DRG's)
43. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Claim
AMA
electronic media
(TPA) Third Party Administrator
44. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
(DOS) Date of Service
ordering physician
e-health information management
etiquette
45. Medical staff member who is legally responsible for the care and treatment given to a patient.
authorization form
attending physician
(POS) Point-of Service Plan
Out of Network (OON)
46. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Participating Provider
Participating Provider
consent
Specialist
47. 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
Open Enrollment
(ERISA) Employee Retirement Income Security Act of 1974
Covered Expenses
48. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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49. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Network
business associate
ee schedule
preauthorization
50. Health Information Portability and Accountability Act
etiquette
HIPAA
pcp
(PPS) Hospital Impatient Prospective Payment System
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