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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. Individually identifiable health information
claim
IIHI
(Non-par) Non-Participating Provider
clearinghouse
2. A willful act by an employee of taking possession of an employer's money
Embezzlement
(PAC) Pre- Admission Certification
Network
Pre-certification
3. The maximum amount a plan pays for a covered service
Allowed Expenses
e-health information management
phantom billing
closed panel HMO
4. 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)
Specialist
Embezzlement
Standard
Consent form
5. A complex technical issue not within the scope of the health care provider's role; refers to instances when state law takes precedence over federal law.
Confidential communication
Specialist
state preemption
(COB) Coordination of Benefits
6. 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
Pre-certification
Medigap Insurance
Confidential communication
prepaid plan
7. 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.
business associate
Privacy officer
ordering physician
closed panel HMO
8. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Deductible
open panel HMO
disclosure
Subscriber
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
hmo
Beneficiary
(DRG's)
(DME) Durable Medical Equipment
10. 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
(DRG's)
attending physician
(COBRA)
Security Rule
11. 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
breach of confidential communication
(PCN) Primary Care Network
business associate
12. 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
premium
transaction
Deductible
(PCP) Primary Care Physician
13. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
preauthorization
Claim
referral
14. 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.
(PCN) Primary Care Network
health care provider
Covered Expenses
(DOS) Date of Service
15. 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
(OOPs) Out of Pocket Costs/Expenses
Out of Network (OON)
(Non-par) Non-Participating Provider
(APC) Ambulatory Patient Classifications
16. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
Subscriber
(EPO) Exclusive Provider Organization
ethics
Specialist
17. 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
Assignment & Authorization
Individually identifiable health information
security officer
(PCN) Primary Care Network
18. Any part of an individual's health information - including demographic information collected from the individual - that is created or received by a covered entity.
Resonable Charge
Medigap Insurance
Individually identifiable health information
ordering physician
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
phantom billing
(PCP) Primary Care Physician
Consent form
epo
20. Verbal or written agreement that gives approval to some action - situation - or statement.
medical foundation
pcp
consent
ordering physician
21. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
nonprivileged information
(EPO) Exclusive Provider Organization
(PPS) Hospital Impatient Prospective Payment System
breach of confidential communication
22. An intentional misrepresentation of the facts to deceive or mislead another.
(PAC) Pre- Admission Certification
fraud
breach of confidential communication
Experimental Procedures
23. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
(Non-par) Non-Participating Provider
hmo
premium
breach of confidential communication
24. A review of the need for inpatient hospital care - completed before the actual admission
deductible
(COBRA)
(PAC) Pre- Admission Certification
(UCR) Usual - Customary and Reasonable
25. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
hmo
open panel HMO
e-health information management
26. 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
Supplementary Medical Insurance
crossover claim
hmo
epo
27. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
Maximum Out Of Pocket
(PEC) Pre-existing condition
(OOPs) Out of Pocket Costs/Expenses
Allowed Expenses
28. American Medical Association
transaction
AMA
Beneficiary
Assignment & Authorization
29. Unauthorized release of information
Privacy officer
(TPA) Third Party Administrator
(PPS) Hospital Impatient Prospective Payment System
breach of confidential communication
30. 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
Preauthorization
Open Enrollment
subscriber
Specialist
31. 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
ppo
(Non-par) Non-Participating Provider
(TPA) Third Party Administrator
32. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
confidentiality
authorization form
crossover claim
prepaid plan
33. Individually identifiable health information
Confidential communication
IIHI
complience plan
claim
34. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
Open Enrollment
claim
Confidential communication
Embezzlement
35. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
clearinghouse
referring physician
e-health information management
claim
36. A health insurance enrollee chooses to see an out of network provider without authorization
Claim
self-referral
medical foundation
authorization form
37. 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
transaction
(POS) Point-of Service Plan
Protected health information
(PCP) Primary Care Physician
38. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
fraud
econdary Payer
subscriber
breach of confidential communication
39. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
preauthorization
phantom billing
Resonable Charge
Coordinated Coverage
40. The period of time that payment for Medicare inpatient hospital benefits are available
business associate
benefit period
closed panel HMO
state preemption
41. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
referral
phantom billing
hmo
Notice of Privacy Practices
42. Standards of conduct generally accepted as a moral guide for behavior.
ethics
phantom billing
(UR) Utilization review
(TPA) Third Party Administrator
43. Medical staff member who is legally responsible for the care and treatment given to a patient.
consulting physician
Specialist
Deductible
attending physician
44. A clinic that is owned by the HMO and the physicians are employees of the HMO
Security Rule
closed panel HMO
ordering physician
claim
45. 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
phantom billing
Covered Expenses
Participating Provider
crossover claim
46. The period of time that payment for Medicare inpatient hospital benefits are available
authorization form
disclosure
closed panel HMO
benefit period
47. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Subscriber
ids
Pre-existing Condition Exclusion
Pre-certification
48. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Resonable Charge
clearinghouse
nonprivileged information
Subscriber
49. 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
(EPO) Exclusive Provider Organization
HIPAA
Medigap Insurance
(PCN) Primary Care Network
50. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
Treating or performing physician
electronic media
Privileged information