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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.
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 willful act by an employee of taking possession of an employer's money
(DRG's)
Embezzlement
referring physician
referral
2. 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
Participating Provider
medical foundation
ethics
3. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
(PCP) Primary Care Physician
complience plan
Sub-acute Care
AMA
4. 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.
health care provider
etiquette
claim
open panel HMO
5. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
prepaid plan
Subscriber
consent
Claim
6. A monthly fee paid by the insured for specific medical insurance coverage
Beneficiary
authorization form
premium
pcp
7. 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
subscriber
epo
Deductible
Experimental Procedures
8. Individually identifiable health information
(EPO) Exclusive Provider Organization
e-health information management
econdary Payer
IIHI
9. A portion of the covered expenses that an insured individual must pay before inusrance coverage with co-insurance goes into effect. Deductibles are usually based on a calander year
Assignment & Authorization
Embezzlement
ppo
Deductible
10. 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
Assignment & Authorization
e-health information management
closed panel HMO
Out of Network (OON)
11. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare
(POS) Point-of Service Plan
(Non-par) Non-Participating Provider
referring physician
(DME) Durable Medical Equipment
12. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
covered entity
e-health information management
(ERISA) Employee Retirement Income Security Act of 1974
Supplementary Medical Insurance
13. A patient claim is eligible for medicare and medicaid
premium
IIHI
cash flow
crossover claim
14. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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15. Someone who is eligible for or receiving benefits under an insurance policy or plan
Amblatory Care
fraud
Treating or performing physician
Beneficiary
16. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
ppo
privacy
Specialist
(OOPs) Out of Pocket Costs/Expenses
17. The period of time that payment for Medicare inpatient hospital benefits are available
ordering physician
Out of Network (OON)
benefit period
Medigap Insurance
18. Is a provider who sends the patients for testing or treatment
referring physician
deductible
(PPS) Hospital Impatient Prospective Payment System
Supplementary Medical Insurance
19. The transmission of information between two parties to carry out financial or administrative activities related to health care.
ordering physician
health care provider
Standard
transaction
20. 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
covered entity
Specialist
clearinghouse
Pre-existing Condition Exclusion
21. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Notice of Privacy Practices
(AOB) Assignment of Benefits
referral
Open Enrollment
22. 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
(POS) Point-of Service Plan
(DRG's)
nonprivileged information
Treating or performing physician
23. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
(ERISA) Employee Retirement Income Security Act of 1974
Assignment & Authorization
Coordinated Coverage
24. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
(POS) Point-of Service Plan
Treating or performing physician
subscriber
25. Also known as out-of-network provider. A healthcare provider who has not contracted with the carrier of a health plan to be a participating provider of healthcare
Standard
(COBRA)
authorization form
(Non-par) Non-Participating Provider
26. A list of the amount to be paid by an insurance company for each procedure service
(UR) Utilization review
referring physician
ee schedule
Deductible
27. Health Information Portability and Accountability Act
(PCN) Primary Care Network
HIPAA
closed panel HMO
clearinghouse
28. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
Participating Provider
confidentiality
Maximum Out Of Pocket
(Non-par) Non-Participating Provider
29. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
abuse
(PPS) Hospital Impatient Prospective Payment System
subscriber
30. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Network
Standard
IIHI
(AOB) Assignment of Benefits
31. 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
Network
Open Enrollment
Experimental Procedures
Participating Provider
32. Medicare's method of paying acute care hospitals for inpatient care
breach of confidential communication
hmo
referral
(PPS) Hospital Impatient Prospective Payment System
33. A health insurance enrollee chooses to see an out of network provider without authorization
HIPAA
transaction
(DRG's)
self-referral
34. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
referring physician
claim
(PAC) Pre- Admission Certification
(DCI) Duplicate Coverage Inquiry
35. Medical staff member who is legally responsible for the care and treatment given to a patient.
phantom billing
hmo
attending physician
prepaid plan
36. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
e-health information management
(TPA) Third Party Administrator
hmo
(DCI) Duplicate Coverage Inquiry
37. A provider who has contracted with the health plan to deliver medical services to covered persons. This includes hospitals - pharmacies or a physician who has contractually accepted the terms and conditions as set forth by the health plan
nonprivileged information
Participating Provider
Experimental Procedures
referral
38. 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.
ppo
Protected health information
IIHI
referring physician
39. 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
hmo
Individually identifiable health information
(PAC) Pre- Admission Certification
Supplementary Medical Insurance
40. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
premium
health care provider
covered entity
41. 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
Out of Network (OON)
(PAC) Pre- Admission Certification
(PCN) Primary Care Network
(EPO) Exclusive Provider Organization
42. 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
open panel HMO
Protected health information
consulting physician
43. 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
e-health information management
electronic media
Maximum Out Of Pocket
complience plan
44. 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
Coordinated Coverage
complience
(PEC) Pre-existing condition
45. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(OOPs) Out of Pocket Costs/Expenses
consulting physician
claim
Open Enrollment
46. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(COB) Coordination of Benefits
security officer
Claim
e-health information management
47. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
breach of confidential communication
Pre-existing Condition Exclusion
Individually identifiable health information
48. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
security officer
complience
(COBRA)
(UR) Utilization review
49. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
ordering physician
Pre-existing Condition Exclusion
covered entity
50. 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
Supplementary Medical Insurance
prepaid plan
ppo
complience
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