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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. 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.
Notice of Privacy Practices
(PCP) Primary Care Physician
(TPA) Third Party Administrator
Assignment & Authorization
2. 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
Consent form
Sub-acute Care
e-health information management
3. 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
(DOS) Date of Service
Privileged information
(OOPs) Out of Pocket Costs/Expenses
pos
4. 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.
(Non-par) Non-Participating Provider
Protected health information
Covered Expenses
Deductible
5. Medical staff member who is legally responsible for the care and treatment given to a patient.
(PCP) Primary Care Physician
econdary Payer
ordering physician
attending physician
6. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
(POS) Point-of Service Plan
(EPO) Exclusive Provider Organization
complience
7. 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
ethics
business associate
complience
8. The maximum amount a plan pays for a covered service
Allowed Expenses
(PAC) Pre- Admission Certification
(APC) Ambulatory Patient Classifications
AMA
9. The transmission of information between two parties to carry out financial or administrative activities related to health care.
referral
transaction
Allowed Expenses
(ERISA) Employee Retirement Income Security Act of 1974
10. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
referral
(ERISA) Employee Retirement Income Security Act of 1974
Embezzlement
subscriber
11. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
self-referral
(PEC) Pre-existing condition
transaction
Protected health information
12. The most money you can expect to pay for covered expenses. Once the max out-of-pocket has been met - the health plan will pay 100% of certain covered expenses
Medigap Insurance
Maximum Out Of Pocket
ee schedule
Resonable Charge
13. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(DOS) Date of Service
prepaid plan
electronic media
referring physician
14. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
electronic media
Open Enrollment
(PCN) Primary Care Network
15. 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)
pcp
Preauthorization
abuse
16. Health Information Portability and Accountability Act
Consent form
HIPAA
(COB) Coordination of Benefits
preauthorization
17. The transmission of information between two parties to carry out financial or administrative activities related to health care.
etiquette
deductible
referral
transaction
18. 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)
phantom billing
privacy
covered entity
Consent form
19. 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
(PCP) Primary Care Physician
Deductible
state preemption
covered entity
20. The dates of healthcare services were provided to the beneficiary
(ERISA) Employee Retirement Income Security Act of 1974
IIHI
(DOS) Date of Service
Specialist
21. An organization of provider sites with a contracted relationship that offer services
ids
Amblatory Care
(PAC) Pre- Admission Certification
Confidential communication
22. 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.
(OOPs) Out of Pocket Costs/Expenses
(PCP) Primary Care Physician
AMA
Notice of Privacy Practices
23. A clinic that is owned by the HMO and the physicians are employees of the HMO
closed panel HMO
subscriber
Resonable Charge
ppo
24. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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25. A willful act by an employee of taking possession of an employer's money
Pre-certification
benefit period
Embezzlement
Experimental Procedures
26. An insurance plan requirement in which you or your primary care physician need to notify your insurance company in advance about certain medical procedures in order for those procedures to be considered a covered expense
(ABN) Advance Beneficiary Notice
Out of Network (OON)
Preauthorization
deductible
27. A rule - condition - or requirement
(UCR) Usual - Customary and Reasonable
Standard
Open Enrollment
(PCP) Primary Care Physician
28. Medicare's method of paying acute care hospitals for inpatient care
(PPS) Hospital Impatient Prospective Payment System
Out of Network (OON)
(COB) Coordination of Benefits
covered entity
29. The dates of healthcare services were provided to the beneficiary
(DOS) Date of Service
(APC) Ambulatory Patient Classifications
(Non-par) Non-Participating Provider
ids
30. 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
Treating or performing physician
(UCR) Usual - Customary and Reasonable
breach of confidential communication
31. A privileged communication that may be disclosed only with the patient's permission.
(COBRA)
Allowed Expenses
(ABN) Advance Beneficiary Notice
Confidential communication
32. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
nonprivileged information
(TPA) Third Party Administrator
(PAC) Pre- Admission Certification
(OOPs) Out of Pocket Costs/Expenses
33. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Supplementary Medical Insurance
Participating Provider
subscriber
complience plan
34. A nonprofit integrated delivery system
Maximum Out Of Pocket
consulting physician
medical foundation
consulting physician
35. 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.
referring physician
business associate
closed panel HMO
privacy
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.
fraud
preauthorization
disclosure
security officer
37. Under HIPAA - regulations related to the security of electronic protected health information that - along with regulations - related to electronic transactions and code sets - privacy - and enforcement - compose the Administrative Simplification prov
state preemption
medical foundation
(DCI) Duplicate Coverage Inquiry
Security Rule
38. 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
ethics
(PEC) Pre-existing condition
epo
Assignment & Authorization
39. 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
Experimental Procedures
(DCI) Duplicate Coverage Inquiry
etiquette
Preauthorization
40. 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
Network
Coordinated Coverage
(PEC) Pre-existing condition
econdary Payer
41. 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
Specialist
nonprivileged information
Pre-existing Condition Exclusion
Supplementary Medical Insurance
42. A health insurance enrollee chooses to see an out of network provider without authorization
breach of confidential communication
closed panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
self-referral
43. 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.
attending physician
(OOPs) Out of Pocket Costs/Expenses
Privileged information
hmo
44. 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
security officer
cash flow
confidentiality
ppo
45. Unauthorized release of information
breach of confidential communication
subscriber
Supplementary Medical Insurance
abuse
46. 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
Maximum Out Of Pocket
Privacy officer
breach of confidential communication
47. A monthly fee paid by the insured for specific medical insurance coverage
health care provider
premium
confidentiality
Supplementary Medical Insurance
48. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(AOB) Assignment of Benefits
authorization form
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
49. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Sub-acute Care
Participating Provider
disclosure
abuse
50. The condition of being secluded from the presence or view of others.
Consent form
subscriber
claim
privacy
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