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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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.
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 term used to refer to the commonly charged or prevailing fees for health services within a geographic area
self-referral
(UCR) Usual - Customary and Reasonable
Treating or performing physician
e-health information management
2. The maximum amount a plan pays for a covered service
(DME) Durable Medical Equipment
Subscriber
Allowed Expenses
Supplementary Medical Insurance
3. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
electronic media
etiquette
Medigap Insurance
(POS) Point-of Service Plan
4. 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
referring physician
epo
(COB) Coordination of Benefits
complience plan
5. 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
pcp
nonprivileged information
(PEC) Pre-existing condition
breach of confidential communication
6. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
health care provider
Standard
Deductible
(DCI) Duplicate Coverage Inquiry
7. What the insurance company will consider paying for as defined in the contract.
privacy
Covered Expenses
Protected health information
Security Rule
8. 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
(POS) Point-of Service Plan
ppo
Privileged information
health care provider
9. 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)
IIHI
Standard
Consent form
(ERISA) Employee Retirement Income Security Act of 1974
10. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
open panel HMO
security officer
complience plan
business associate
11. Is a provider who sends the patients for testing or treatment
referring physician
(PCP) Primary Care Physician
subscriber
hmo
12. 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
(Non-par) Non-Participating Provider
ids
business associate
Resonable Charge
13. Unauthorized release of information
breach of confidential communication
hmo
Preauthorization
Assignment & Authorization
14. 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
Individually identifiable health information
Experimental Procedures
AMA
privacy
15. 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
Specialist
pos
Security Rule
(OOPs) Out of Pocket Costs/Expenses
16. 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
AMA
Coordinated Coverage
ppo
abuse
17. Health Information Portability and Accountability Act
(OOPs) Out of Pocket Costs/Expenses
HIPAA
Assignment & Authorization
complience plan
18. 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.
(PEC) Pre-existing condition
health care provider
(COBRA)
ordering physician
19. 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
attending physician
Sub-acute Care
Protected health information
Embezzlement
20. An organization of provider sites with a contracted relationship that offer services
ids
Security Rule
benefit period
Security Rule
21. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
crossover claim
(ERISA) Employee Retirement Income Security Act of 1974
(COBRA)
22. Standards of conduct generally accepted as a moral guide for behavior.
(TPA) Third Party Administrator
ethics
consulting physician
security officer
23. Is the provider who renders a service to a patient
Treating or performing physician
Assignment & Authorization
Privacy officer
Covered Expenses
24. 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
nonprivileged information
Pre-existing Condition Exclusion
Experimental Procedures
electronic media
25. Standards of conduct generally accepted as a moral guide for behavior.
ethics
(UCR) Usual - Customary and Reasonable
Medigap Insurance
nonprivileged information
26. 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
Pre-existing Condition Exclusion
Maximum Out Of Pocket
subscriber
Preauthorization
27. 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
confidentiality
confidentiality
(UR) Utilization review
28. 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
IIHI
Preauthorization
etiquette
Deductible
29. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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30. 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
(DRG's)
Experimental Procedures
(DCI) Duplicate Coverage Inquiry
31. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
pos
security officer
(APC) Ambulatory Patient Classifications
32. 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
ordering physician
Maximum Out Of Pocket
health care provider
Pre-existing Condition Exclusion
33. Medicare's method of paying acute care hospitals for inpatient care
privacy
(Non-par) Non-Participating Provider
(PPS) Hospital Impatient Prospective Payment System
Claim
34. Someone who is eligible for or receiving benefits under an insurance policy or plan
Beneficiary
(DME) Durable Medical Equipment
(DOS) Date of Service
(UR) Utilization review
35. A monthly fee paid by the insured for specific medical insurance coverage
medical foundation
Privileged information
fraud
premium
36. The amount of actual money available to the medical practice
Individually identifiable health information
cash flow
Open Enrollment
medical foundation
37. 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
Privileged information
(OOPs) Out of Pocket Costs/Expenses
pos
38. 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.
Notice of Privacy Practices
(PPS) Hospital Impatient Prospective Payment System
disclosure
Network
39. A clinic that is owned by the HMO and the physicians are employees of the HMO
disclosure
Security Rule
closed panel HMO
ppo
40. 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
pos
etiquette
crossover claim
41. 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
(ERISA) Employee Retirement Income Security Act of 1974
authorization form
closed panel HMO
health care provider
42. Approval or consent by a primary physician for patient referral to ancillary services and specialists
ordering physician
econdary Payer
HIPAA
Referral
43. 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
state preemption
security officer
Assignment & Authorization
Confidential communication
44. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
Coordinated Coverage
electronic media
claim
pcp
45. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
AMA
pcp
nonprivileged information
Claim
46. 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
complience
Deductible
abuse
(PPS) Hospital Impatient Prospective Payment System
47. The condition of being secluded from the presence or view of others.
ppo
privacy
(PPS) Hospital Impatient Prospective Payment System
(POS) Point-of Service Plan
48. A privileged communication that may be disclosed only with the patient's permission.
consulting physician
crossover claim
Claim
Confidential communication
49. 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
epo
confidentiality
(ERISA) Employee Retirement Income Security Act of 1974
transaction
50. 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
(PEC) Pre-existing condition
Sub-acute Care
Resonable Charge