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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.
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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 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
Preauthorization
(PCN) Primary Care Network
(DCI) Duplicate Coverage Inquiry
ethics
2. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Privacy officer
claim
Subscriber
(Non-par) Non-Participating Provider
3. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
complience plan
preauthorization
(OOPs) Out of Pocket Costs/Expenses
electronic media
4. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
(PAC) Pre- Admission Certification
etiquette
ppo
electronic media
5. 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.
electronic media
Notice of Privacy Practices
Resonable Charge
IIHI
6. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
(TPA) Third Party Administrator
Protected health information
ids
subscriber
7. 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
preauthorization
(UCR) Usual - Customary and Reasonable
etiquette
(DME) Durable Medical Equipment
8. 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
open panel HMO
Security Rule
Specialist
claim
9. Standards of conduct generally accepted as a moral guide for behavior.
ethics
authorization form
attending physician
(UR) Utilization review
10. A provision that apples when a person is covered under more than one group medical program
ids
(COB) Coordination of Benefits
(PEC) Pre-existing condition
epo
11. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Specialist
consulting physician
fraud
complience plan
12. 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.
Amblatory Care
Protected health information
health care provider
(UCR) Usual - Customary and Reasonable
13. Is a provider who sends the patients for testing or treatment
nonprivileged information
Medigap Insurance
referring physician
(TPA) Third Party Administrator
14. 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)
Consent form
closed panel HMO
Protected health information
abuse
15. A review of the need for inpatient hospital care - completed before the actual admission
(PAC) Pre- Admission Certification
Privacy officer
e-health information management
benefit period
16. Individually identifiable health information
attending physician
pos
epo
IIHI
17. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
complience
preauthorization
deductible
hmo
18. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
Subscriber
clearinghouse
consent
hmo
19. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Individually identifiable health information
Privacy officer
preauthorization
health care provider
20. A patient claim is eligible for medicare and medicaid
crossover claim
Network
Standard
security officer
21. 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
Security Rule
privacy
Preauthorization
econdary Payer
22. 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
IIHI
transaction
Open Enrollment
referral
23. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(OOPs) Out of Pocket Costs/Expenses
(UCR) Usual - Customary and Reasonable
Claim
hmo
24. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
HIPAA
pcp
(AOB) Assignment of Benefits
subscriber
25. A nonprofit integrated delivery system
Covered Expenses
econdary Payer
medical foundation
Subscriber
26. Standards of conduct generally accepted as a moral guide for behavior.
Claim
Allowed Expenses
ethics
Notice of Privacy Practices
27. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(PEC) Pre-existing condition
Resonable Charge
hmo
Subscriber
28. 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.
subscriber
disclosure
ee schedule
business associate
29. 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
pos
(ABN) Advance Beneficiary Notice
Individually identifiable health information
(COB) Coordination of Benefits
30. 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
(COBRA)
Resonable Charge
Preauthorization
epo
31. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Supplementary Medical Insurance
(UCR) Usual - Customary and Reasonable
authorization form
premium
32. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(ERISA) Employee Retirement Income Security Act of 1974
(DCI) Duplicate Coverage Inquiry
ethics
(COBRA)
33. An organization of provider sites with a contracted relationship that offer services
phantom billing
ids
disclosure
confidentiality
34. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(ERISA) Employee Retirement Income Security Act of 1974
Notice of Privacy Practices
Notice of Privacy Practices
referral
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.
(ERISA) Employee Retirement Income Security Act of 1974
(UCR) Usual - Customary and Reasonable
Privacy officer
Protected health information
36. 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
(ERISA) Employee Retirement Income Security Act of 1974
Security Rule
medical foundation
Treating or performing physician
37. An organization of provider sites with a contracted relationship that offer services
phantom billing
Experimental Procedures
ids
ee schedule
38. The period of time that payment for Medicare inpatient hospital benefits are available
Assignment & Authorization
covered entity
ethics
benefit period
39. The condition of being secluded from the presence or view of others.
ee schedule
Consent form
Protected health information
privacy
40. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
e-health information management
Covered Expenses
security officer
Individually identifiable health information
41. 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.
phantom billing
AMA
attending physician
security officer
42. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
e-health information management
(DOS) Date of Service
Privacy officer
43. A federal law that requires employers to offer continued health insurance coverage to certain employees and their beneficiaries whose group health insurance coverage has been terminated
security officer
(ERISA) Employee Retirement Income Security Act of 1974
(COBRA)
benefit period
44. The maximum amount a plan pays for a covered service
pcp
Experimental Procedures
Allowed Expenses
Treating or performing physician
45. 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
clearinghouse
(Non-par) Non-Participating Provider
Coordinated Coverage
security officer
46. 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
preauthorization
Pre-certification
pcp
47. 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
deductible
(UR) Utilization review
Assignment & Authorization
Pre-existing Condition Exclusion
48. 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
(PPS) Hospital Impatient Prospective Payment System
Pre-existing Condition Exclusion
econdary Payer
Covered Expenses
49. American Medical Association
econdary Payer
(ABN) Advance Beneficiary Notice
Claim
AMA
50. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
(COBRA)
Resonable Charge
business associate
clearinghouse