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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. 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
(DOS) Date of Service
Experimental Procedures
(PCN) Primary Care Network
open panel HMO
2. 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
privacy
(ERISA) Employee Retirement Income Security Act of 1974
Privileged information
transaction
3. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
pcp
(DCI) Duplicate Coverage Inquiry
(Non-par) Non-Participating Provider
fraud
4. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
deductible
Notice of Privacy Practices
Network
ethics
5. 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
Treating or performing physician
Privacy officer
Claim
6. A fee is considered 'Reasonable' if it is both usual and customary or if it is justified because there is a complex problem involved
Resonable Charge
phantom billing
(POS) Point-of Service Plan
premium
7. Someone who is eligible for or receiving benefits under an insurance policy or plan
Resonable Charge
Beneficiary
complience plan
premium
8. The condition of being secluded from the presence or view of others.
business associate
(EPO) Exclusive Provider Organization
Medigap Insurance
privacy
9. 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
consent
etiquette
Pre-existing Condition Exclusion
Specialist
10. Approval or consent by a primary physician for patient referral to ancillary services and specialists
deductible
Referral
cash flow
complience plan
11. 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
pos
Security Rule
(PEC) Pre-existing condition
complience
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.
Standard
consent
security officer
Maximum Out Of Pocket
13. 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.
Subscriber
disclosure
Notice of Privacy Practices
Subscriber
14. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
health care provider
(APC) Ambulatory Patient Classifications
(DOS) Date of Service
ordering physician
15. 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
(PCP) Primary Care Physician
hmo
Specialist
(UR) Utilization review
16. What the insurance company will consider paying for as defined in the contract.
cash flow
(ERISA) Employee Retirement Income Security Act of 1974
Covered Expenses
phantom billing
17. 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
epo
subscriber
Standard
(PCN) Primary Care Network
18. A provision that apples when a person is covered under more than one group medical program
Assignment & Authorization
Privileged information
Pre-existing Condition Exclusion
(COB) Coordination of Benefits
19. 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
(COB) Coordination of Benefits
Privileged information
deductible
20. Is the provider who renders a service to a patient
Treating or performing physician
security officer
referring physician
(UCR) Usual - Customary and Reasonable
21. Customs - rules of conduct - courtesy - and manners of the medical profession
health care provider
privacy
etiquette
medical foundation
22. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
Subscriber
e-health information management
Amblatory Care
(ABN) Advance Beneficiary Notice
23. 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
Embezzlement
business associate
prepaid plan
Privacy officer
24. 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
(COBRA)
(DRG's)
Coordinated Coverage
health care provider
25. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
nonprivileged information
(PAC) Pre- Admission Certification
claim
Individually identifiable health information
26. A nonprofit integrated delivery system
crossover claim
AMA
confidentiality
medical foundation
27. A patient claim is eligible for medicare and medicaid
Experimental Procedures
crossover claim
ordering physician
(PCP) Primary Care Physician
28. A list of the amount to be paid by an insurance company for each procedure service
ee schedule
Notice of Privacy Practices
attending physician
Deductible
29. Health Information Portability and Accountability Act
ethics
state preemption
crossover claim
HIPAA
30. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
pcp
Specialist
fraud
(Non-par) Non-Participating Provider
31. 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
Experimental Procedures
prepaid plan
medical foundation
32. 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
Preauthorization
(COBRA)
ethics
attending physician
33. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
breach of confidential communication
(DCI) Duplicate Coverage Inquiry
Covered Expenses
Resonable Charge
34. 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
Subscriber
Allowed Expenses
(DME) Durable Medical Equipment
ppo
35. A patient claim is eligible for medicare and medicaid
(PAC) Pre- Admission Certification
Network
crossover claim
confidentiality
36. An entity that transmits health information in electronic form in connection with a transaction covered by HIPAA. The covered entity may be a helath care coverage carrier such as Blue Cross - a health care clearinghouse through which claims are submi
(PAC) Pre- Admission Certification
pos
covered entity
(Non-par) Non-Participating Provider
37. A physician who specializes in a specific area of medicine - such as cardiology - oncology - urology
self-referral
(APC) Ambulatory Patient Classifications
(PPS) Hospital Impatient Prospective Payment System
Specialist
38. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
epo
Network
HIPAA
attending physician
39. 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
Coordinated Coverage
Specialist
(Non-par) Non-Participating Provider
Privacy officer
40. 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
Claim
Deductible
(APC) Ambulatory Patient Classifications
(Non-par) Non-Participating Provider
41. 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
nonprivileged information
cash flow
Confidential communication
42. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
deductible
Sub-acute Care
AMA
e-health information management
43. Is a provider who sends the patients for testing or treatment
(PCP) Primary Care Physician
AMA
Coordinated Coverage
referring physician
44. 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
Standard
Out of Network (OON)
Subscriber
(DCI) Duplicate Coverage Inquiry
45. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
Subscriber
Confidential communication
(COBRA)
complience
46. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
health care provider
nonprivileged information
(UCR) Usual - Customary and Reasonable
(PEC) Pre-existing condition
47. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
authorization form
referral
state preemption
self-referral
48. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
consent
complience plan
(PEC) Pre-existing condition
Privileged information
49. Individually identifiable health information
(UR) Utilization review
IIHI
(OOPs) Out of Pocket Costs/Expenses
Out of Network (OON)
50. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
(APC) Ambulatory Patient Classifications
Notice of Privacy Practices
referral
abuse