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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. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
confidentiality
Claim
Resonable Charge
Network
2. A structure for classifying outpatient services and procedures for purpose of payment
Individually identifiable health information
(ABN) Advance Beneficiary Notice
referral
(APC) Ambulatory Patient Classifications
3. 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
confidentiality
Security Rule
(PAC) Pre- Admission Certification
Privileged information
4. 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
Claim
claim
ppo
referring physician
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
Experimental Procedures
Participating Provider
(EPO) Exclusive Provider Organization
deductible
6. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
pos
(COBRA)
(APC) Ambulatory Patient Classifications
hmo
7. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
Protected health information
ordering physician
Confidential communication
crossover claim
8. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(Non-par) Non-Participating Provider
(UR) Utilization review
clearinghouse
ethics
9. 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
(DME) Durable Medical Equipment
crossover claim
(OOPs) Out of Pocket Costs/Expenses
Notice of Privacy Practices
10. American Medical Association
privacy
consent
AMA
(UCR) Usual - Customary and Reasonable
11. 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
epo
abuse
nonprivileged information
(DCI) Duplicate Coverage Inquiry
12. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
complience plan
Subscriber
(Non-par) Non-Participating Provider
consulting physician
13. Verbal or written agreement that gives approval to some action - situation - or statement.
(Non-par) Non-Participating Provider
(PCP) Primary Care Physician
Sub-acute Care
consent
14. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
abuse
authorization form
(OOPs) Out of Pocket Costs/Expenses
Specialist
15. 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
(APC) Ambulatory Patient Classifications
Sub-acute Care
Coordinated Coverage
medical foundation
16. 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
Security Rule
nonprivileged information
Supplementary Medical Insurance
Open Enrollment
17. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
claim
breach of confidential communication
health care provider
Resonable Charge
18. Customs - rules of conduct - courtesy - and manners of the medical profession
Consent form
etiquette
(COB) Coordination of Benefits
Open Enrollment
19. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
confidentiality
closed panel HMO
electronic media
(DCI) Duplicate Coverage Inquiry
20. Is the provider who renders a service to a patient
health care provider
Treating or performing physician
epo
(APC) Ambulatory Patient Classifications
21. 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
cash flow
Out of Network (OON)
referring physician
authorization form
22. 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
(ERISA) Employee Retirement Income Security Act of 1974
complience plan
Network
Preauthorization
23. Someone who is eligible for or receiving benefits under an insurance policy or plan
Confidential communication
Beneficiary
health care provider
clearinghouse
24. 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
Pre-certification
Amblatory Care
Network
25. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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26. Integrating benefits payable under more than one health insurance.
Privacy officer
business associate
Coordinated Coverage
(ERISA) Employee Retirement Income Security Act of 1974
27. Is a provider who sends the patients for testing or treatment
electronic media
referring physician
(PEC) Pre-existing condition
(AOB) Assignment of Benefits
28. 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
Pre-existing Condition Exclusion
ids
(AOB) Assignment of Benefits
(Non-par) Non-Participating Provider
29. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Individually identifiable health information
preauthorization
epo
Sub-acute Care
30. 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
(DRG's)
IIHI
e-health information management
authorization form
31. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
hmo
(ABN) Advance Beneficiary Notice
claim
32. Individually identifiable health information
(APC) Ambulatory Patient Classifications
IIHI
(COBRA)
complience plan
33. 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
IIHI
Specialist
premium
(POS) Point-of Service Plan
34. Medical staff member who is legally responsible for the care and treatment given to a patient.
(PPS) Hospital Impatient Prospective Payment System
Preauthorization
attending physician
Security Rule
35. 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
health care provider
Supplementary Medical Insurance
econdary Payer
etiquette
36. A willful act by an employee of taking possession of an employer's money
Embezzlement
(COB) Coordination of Benefits
business associate
claim
37. 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
ethics
(COBRA)
Network
(Non-par) Non-Participating Provider
38. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
open panel HMO
prepaid plan
(EPO) Exclusive Provider Organization
(PCP) Primary Care Physician
39. 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.
Individually identifiable health information
Privileged information
(PCN) Primary Care Network
(PEC) Pre-existing condition
40. 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
(ABN) Advance Beneficiary Notice
(EPO) Exclusive Provider Organization
open panel HMO
breach of confidential communication
41. 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
hmo
Preauthorization
(EPO) Exclusive Provider Organization
Amblatory Care
42. 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
crossover claim
(Non-par) Non-Participating Provider
Sub-acute Care
(DME) Durable Medical Equipment
43. 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
benefit period
pos
pcp
Coordinated Coverage
44. A review of the need for inpatient hospital care - completed before the actual admission
Consent form
(PAC) Pre- Admission Certification
premium
cash flow
45. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
business associate
health care provider
electronic media
46. A provision that apples when a person is covered under more than one group medical program
pos
Specialist
subscriber
(COB) Coordination of Benefits
47. A willful act by an employee of taking possession of an employer's money
confidentiality
Embezzlement
Preauthorization
Maximum Out Of Pocket
48. Someone who is eligible for or receiving benefits under an insurance policy or plan
(ERISA) Employee Retirement Income Security Act of 1974
confidentiality
pos
Beneficiary
49. 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.
premium
security officer
Supplementary Medical Insurance
subscriber
50. American Medical Association
Network
AMA
fraud
complience