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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. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
ee schedule
Specialist
Beneficiary
disclosure
2. Medical services provided on an outpatient basis
Participating Provider
Amblatory Care
prepaid plan
(UCR) Usual - Customary and Reasonable
3. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
breach of confidential communication
(OOPs) Out of Pocket Costs/Expenses
ppo
Medigap Insurance
4. 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
electronic media
(AOB) Assignment of Benefits
(COB) Coordination of Benefits
IIHI
5. Billing for services not performed
authorization form
phantom billing
(EPO) Exclusive Provider Organization
covered entity
6. 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
(UR) Utilization review
Treating or performing physician
Out of Network (OON)
epo
7. A health insurance enrollee chooses to see an out of network provider without authorization
ee schedule
security officer
self-referral
benefit period
8. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
econdary Payer
subscriber
ordering physician
security officer
9. A structure for classifying outpatient services and procedures for purpose of payment
(APC) Ambulatory Patient Classifications
confidentiality
Allowed Expenses
cash flow
10. 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
fraud
Maximum Out Of Pocket
prepaid plan
Security Rule
11. Medical staff member who is legally responsible for the care and treatment given to a patient.
fraud
Notice of Privacy Practices
Standard
attending physician
12. 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.
nonprivileged information
Protected health information
Pre-existing Condition Exclusion
security officer
13. 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
privacy
health care provider
prepaid plan
premium
14. 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.
covered entity
Subscriber
Notice of Privacy Practices
privacy
15. 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
Deductible
covered entity
(ABN) Advance Beneficiary Notice
(AOB) Assignment of Benefits
16. An intentional misrepresentation of the facts to deceive or mislead another.
(COBRA)
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
fraud
17. A rule - condition - or requirement
authorization form
state preemption
Standard
transaction
18. 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
Resonable Charge
Pre-existing Condition Exclusion
Assignment & Authorization
transaction
19. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(EPO) Exclusive Provider Organization
prepaid plan
ordering physician
breach of confidential communication
20. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Subscriber
fraud
referral
clearinghouse
21. 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
(ABN) Advance Beneficiary Notice
(OOPs) Out of Pocket Costs/Expenses
complience plan
premium
22. 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
(COB) Coordination of Benefits
Deductible
breach of confidential communication
Experimental Procedures
23. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
(TPA) Third Party Administrator
ids
pcp
(PPS) Hospital Impatient Prospective Payment System
24. 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
etiquette
Open Enrollment
authorization form
electronic media
25. 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)
referral
Notice of Privacy Practices
Consent form
referring physician
26. A monthly fee paid by the insured for specific medical insurance coverage
Open Enrollment
Beneficiary
Treating or performing physician
premium
27. The condition of being secluded from the presence or view of others.
attending physician
Resonable Charge
privacy
Beneficiary
28. 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
self-referral
Privileged information
prepaid plan
29. Medical staff member who is legally responsible for the care and treatment given to a patient.
Sub-acute Care
attending physician
(UCR) Usual - Customary and Reasonable
e-health information management
30. Customs - rules of conduct - courtesy - and manners of the medical profession
econdary Payer
transaction
etiquette
(UR) Utilization review
31. A privileged communication that may be disclosed only with the patient's permission.
Confidential communication
pcp
benefit period
Maximum Out Of Pocket
32. 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)
(UCR) Usual - Customary and Reasonable
Preauthorization
Individually identifiable health information
33. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
Assignment & Authorization
consent
(COBRA)
consulting physician
34. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
complience plan
fraud
premium
35. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
Notice of Privacy Practices
(UR) Utilization review
ee schedule
Participating Provider
36. Integrating benefits payable under more than one health insurance.
Coordinated Coverage
(POS) Point-of Service Plan
(UR) Utilization review
e-health information management
37. 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
Notice of Privacy Practices
Amblatory Care
Assignment & Authorization
closed panel HMO
38. 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
(UR) Utilization review
nonprivileged information
Participating Provider
closed panel HMO
39. 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
etiquette
transaction
premium
Assignment & Authorization
40. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
ids
(DCI) Duplicate Coverage Inquiry
Specialist
disclosure
41. 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.
(Non-par) Non-Participating Provider
abuse
business associate
epo
42. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
claim
ids
Subscriber
fraud
43. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(EPO) Exclusive Provider Organization
clearinghouse
Preauthorization
Standard
44. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Open Enrollment
cash flow
self-referral
clearinghouse
45. A rule - condition - or requirement
Standard
Privacy officer
(ABN) Advance Beneficiary Notice
confidentiality
46. Is the provider who renders a service to a patient
Treating or performing physician
hmo
(PEC) Pre-existing condition
ee schedule
47. The period of time that payment for Medicare inpatient hospital benefits are available
covered entity
crossover claim
deductible
benefit period
48. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
ordering physician
hmo
breach of confidential communication
Coordinated Coverage
49. Verbal or written agreement that gives approval to some action - situation - or statement.
referring physician
ethics
Treating or performing physician
consent
50. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Sub-acute Care
self-referral
Individually identifiable health information