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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.
If you are not ready to take this test, you can
study here
.
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 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
Individually identifiable health information
business associate
Assignment & Authorization
epo
2. A clinic that is owned by the HMO and the physicians are employees of the HMO
(PEC) Pre-existing condition
open panel HMO
closed panel HMO
Beneficiary
3. A privileged communication that may be disclosed only with the patient's permission.
Amblatory Care
phantom billing
Confidential communication
Allowed Expenses
4. 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
Specialist
breach of confidential communication
clearinghouse
5. 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
disclosure
business associate
(AOB) Assignment of Benefits
Experimental Procedures
6. 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
(TPA) Third Party Administrator
Sub-acute Care
confidentiality
7. A provision that apples when a person is covered under more than one group medical program
abuse
pos
(COB) Coordination of Benefits
(Non-par) Non-Participating Provider
8. Integrating benefits payable under more than one health insurance.
ethics
health care provider
crossover claim
Coordinated Coverage
9. 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
nonprivileged information
claim
(DOS) Date of Service
fraud
10. The condition of being secluded from the presence or view of others.
privacy
(AOB) Assignment of Benefits
ethics
abuse
11. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Medigap Insurance
fraud
confidentiality
(PCP) Primary Care Physician
12. What the insurance company will consider paying for as defined in the contract.
cash flow
privacy
Covered Expenses
Amblatory Care
13. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Coordinated Coverage
referring physician
Pre-certification
e-health information management
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
Pre-existing Condition Exclusion
Amblatory Care
Privileged information
(PEC) Pre-existing condition
15. 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
(PPS) Hospital Impatient Prospective Payment System
Consent form
cash flow
16. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(DRG's)
Maximum Out Of Pocket
(PEC) Pre-existing condition
confidentiality
17. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
(EPO) Exclusive Provider Organization
benefit period
Embezzlement
18. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
disclosure
Out of Network (OON)
referral
consent
19. 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.
Experimental Procedures
ordering physician
(COB) Coordination of Benefits
state preemption
20. An organization of provider sites with a contracted relationship that offer services
(ERISA) Employee Retirement Income Security Act of 1974
Standard
ids
(UR) Utilization review
21. A patient claim is eligible for medicare and medicaid
crossover claim
ordering physician
Covered Expenses
Beneficiary
22. 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
etiquette
(APC) Ambulatory Patient Classifications
Medigap Insurance
23. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
Out of Network (OON)
pcp
(PEC) Pre-existing condition
consent
24. 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.
(DME) Durable Medical Equipment
(DRG's)
state preemption
Participating Provider
25. A health insurance enrollee chooses to see an out of network provider without authorization
Claim
ee schedule
consulting physician
self-referral
26. A provision that apples when a person is covered under more than one group medical program
Notice of Privacy Practices
Allowed Expenses
(COB) Coordination of Benefits
consulting physician
27. Is the provider who renders a service to a patient
Preauthorization
Referral
Treating or performing physician
clearinghouse
28. Is a provider who sends the patients for testing or treatment
referring physician
ids
Referral
Notice of Privacy Practices
29. Unauthorized release of information
breach of confidential communication
complience plan
clearinghouse
Notice of Privacy Practices
30. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Privacy officer
self-referral
deductible
medical foundation
31. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Embezzlement
ordering physician
(UCR) Usual - Customary and Reasonable
Claim
32. A rule - condition - or requirement
hmo
Standard
closed panel HMO
business associate
33. 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
Referral
(EPO) Exclusive Provider Organization
pos
Open Enrollment
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
Out of Network (OON)
(OOPs) Out of Pocket Costs/Expenses
(DME) Durable Medical Equipment
Preauthorization
35. 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
pos
(PEC) Pre-existing condition
Security Rule
Deductible
36. 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
open panel HMO
Pre-existing Condition Exclusion
hmo
disclosure
37. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Out of Network (OON)
Individually identifiable health information
(APC) Ambulatory Patient Classifications
(PPS) Hospital Impatient Prospective Payment System
38. Approval or consent by a primary physician for patient referral to ancillary services and specialists
Referral
breach of confidential communication
security officer
Supplementary Medical Insurance
39. 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
(UR) Utilization review
referral
(ERISA) Employee Retirement Income Security Act of 1974
Protected health information
40. 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
nonprivileged information
Subscriber
epo
Consent form
41. 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
(PEC) Pre-existing condition
authorization form
Assignment & Authorization
Consent form
42. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
(APC) Ambulatory Patient Classifications
consulting physician
(AOB) Assignment of Benefits
43. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Subscriber
benefit period
ordering physician
Open Enrollment
44. 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.
transaction
etiquette
Protected health information
crossover claim
45. The period of time that payment for Medicare inpatient hospital benefits are available
epo
benefit period
pcp
breach of confidential communication
46. 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
prepaid plan
phantom billing
Embezzlement
47. 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
(DME) Durable Medical Equipment
econdary Payer
e-health information management
Notice of Privacy Practices
48. 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
breach of confidential communication
privacy
crossover claim
pos
49. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(DOS) Date of Service
Claim
clearinghouse
subscriber
50. The amount of actual money available to the medical practice
preauthorization
cash flow
Open Enrollment
Network