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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. Is a provider who sends the patients for testing or treatment
security officer
(Non-par) Non-Participating Provider
pos
referring physician
2. 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
Resonable Charge
electronic media
Pre-existing Condition Exclusion
state preemption
3. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
Embezzlement
(ABN) Advance Beneficiary Notice
covered entity
preauthorization
4. 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
transaction
Amblatory Care
(DME) Durable Medical Equipment
premium
5. 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
authorization form
covered entity
(ABN) Advance Beneficiary Notice
6. An organization of provider sites with a contracted relationship that offer services
deductible
ids
(Non-par) Non-Participating Provider
(PCP) Primary Care Physician
7. The transmission of information between two parties to carry out financial or administrative activities related to health care.
(PCN) Primary Care Network
prepaid plan
health care provider
transaction
8. An intentional misrepresentation of the facts to deceive or mislead another.
(POS) Point-of Service Plan
fraud
Subscriber
Participating Provider
9. Billing for services not performed
authorization form
(DRG's)
phantom billing
complience
10. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
Supplementary Medical Insurance
medical foundation
(UCR) Usual - Customary and Reasonable
cash flow
11. 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
Sub-acute Care
health care provider
Assignment & Authorization
deductible
12. A provision that apples when a person is covered under more than one group medical program
econdary Payer
(COB) Coordination of Benefits
(ABN) Advance Beneficiary Notice
Pre-certification
13. Customs - rules of conduct - courtesy - and manners of the medical profession
claim
phantom billing
state preemption
etiquette
14. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Security Rule
state preemption
state preemption
15. Verbal or written agreement that gives approval to some action - situation - or statement.
referring physician
state preemption
Allowed Expenses
consent
16. A privileged communication that may be disclosed only with the patient's permission.
business associate
Out of Network (OON)
ppo
Confidential communication
17. A willful act by an employee of taking possession of an employer's money
self-referral
clearinghouse
disclosure
Embezzlement
18. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
(PCP) Primary Care Physician
Subscriber
attending physician
covered entity
19. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
ee schedule
premium
(AOB) Assignment of Benefits
confidentiality
20. 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
Preauthorization
IIHI
(PEC) Pre-existing condition
Maximum Out Of Pocket
21. Someone who is eligible for or receiving benefits under an insurance policy or plan
(DRG's)
Covered Expenses
(PEC) Pre-existing condition
Beneficiary
22. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
(PAC) Pre- Admission Certification
Confidential communication
Claim
Preauthorization
23. 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
nonprivileged information
Supplementary Medical Insurance
(APC) Ambulatory Patient Classifications
(Non-par) Non-Participating Provider
24. Medicare's method of paying acute care hospitals for inpatient care
(APC) Ambulatory Patient Classifications
(PPS) Hospital Impatient Prospective Payment System
Supplementary Medical Insurance
(COBRA)
25. 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
hmo
disclosure
(COBRA)
transaction
26. Someone who is eligible for or receiving benefits under an insurance policy or plan
(PCN) Primary Care Network
security officer
Subscriber
Beneficiary
27. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
claim
e-health information management
electronic media
transaction
28. 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
Beneficiary
Resonable Charge
disclosure
29. 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
(DRG's)
(ERISA) Employee Retirement Income Security Act of 1974
Subscriber
phantom billing
30. Programs designed to reduce unnecessary medical services - both inpatient and outpatient
(ABN) Advance Beneficiary Notice
(POS) Point-of Service Plan
(UR) Utilization review
fraud
31. Approval or consent by a primary physician for patient referral to ancillary services and specialists
disclosure
Referral
IIHI
Standard
32. 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
(APC) Ambulatory Patient Classifications
(UCR) Usual - Customary and Reasonable
(PCN) Primary Care Network
Experimental Procedures
33. 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
Protected health information
electronic media
(PCN) Primary Care Network
prepaid plan
34. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
Pre-certification
Out of Network (OON)
premium
premium
35. 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)
(PEC) Pre-existing condition
deductible
Supplementary Medical Insurance
36. The condition of being secluded from the presence or view of others.
privacy
breach of confidential communication
state preemption
ppo
37. 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.
cash flow
Privileged information
business associate
complience plan
38. 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
(APC) Ambulatory Patient Classifications
Coordinated Coverage
Participating Provider
confidentiality
39. 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
benefit period
Participating Provider
(POS) Point-of Service Plan
Confidential communication
40. Verbal or written agreement that gives approval to some action - situation - or statement.
medical foundation
pos
consent
(COB) Coordination of Benefits
41. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Confidential communication
ppo
complience plan
Medigap Insurance
42. 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
consulting physician
nonprivileged information
ppo
claim
43. 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
subscriber
Individually identifiable health information
HIPAA
44. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
prepaid plan
(EPO) Exclusive Provider Organization
preauthorization
Covered Expenses
45. 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
consulting physician
deductible
ppo
phantom billing
46. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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47. Health Information Portability and Accountability Act
fraud
etiquette
HIPAA
(TPA) Third Party Administrator
48. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
disclosure
(COBRA)
clearinghouse
(DCI) Duplicate Coverage Inquiry
49. 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
health care provider
Protected health information
Security Rule
Pre-existing Condition Exclusion
50. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
deductible
Sub-acute Care
phantom billing
Participating Provider