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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. A nonprofit integrated delivery system
(PCN) Primary Care Network
medical foundation
benefit period
Out of Network (OON)
2. 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
medical foundation
Resonable Charge
(ERISA) Employee Retirement Income Security Act of 1974
Experimental Procedures
3. 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
Maximum Out Of Pocket
Embezzlement
Open Enrollment
epo
4. The condition of being secluded from the presence or view of others.
(TPA) Third Party Administrator
privacy
Privileged information
open panel HMO
5. A written and documented request for reimbursement for an eligible expense to the insurance company in a correct and timely manner
(OOPs) Out of Pocket Costs/Expenses
open panel HMO
Coordinated Coverage
claim
6. Medical services provided on an outpatient basis
complience plan
complience
Amblatory Care
business associate
7. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
epo
Individually identifiable health information
Allowed Expenses
8. Individually identifiable health information
IIHI
confidentiality
AMA
Privileged information
9. Paperwork for the insurance company that is required from the PCP to send a patient to see a medical specialist for treatment
Pre-certification
(UR) Utilization review
attending physician
referral
10. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
Resonable Charge
(TPA) Third Party Administrator
Treating or performing physician
11. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
(DRG's)
Allowed Expenses
(PPS) Hospital Impatient Prospective Payment System
(EPO) Exclusive Provider Organization
12. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
HIPAA
Subscriber
Experimental Procedures
(PEC) Pre-existing condition
13. American Medical Association
premium
AMA
phantom billing
ids
14. A review of the need for inpatient hospital care - completed before the actual admission
(ABN) Advance Beneficiary Notice
Individually identifiable health information
(PAC) Pre- Admission Certification
attending physician
15. 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.
epo
business associate
Embezzlement
nonprivileged information
16. Health Information Portability and Accountability Act
Beneficiary
AMA
HIPAA
Privacy officer
17. 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
Maximum Out Of Pocket
open panel HMO
privacy
(COBRA)
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
health care provider
Pre-existing Condition Exclusion
Subscriber
consulting physician
19. A monthly fee paid by the insured for specific medical insurance coverage
Allowed Expenses
attending physician
premium
confidentiality
20. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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21. An independent person or corporate enitity(third party) that administers group benefits - claims and administration for a self-insured company or group
Beneficiary
(TPA) Third Party Administrator
premium
Deductible
22. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
Privileged information
Privacy officer
ee schedule
(DOS) Date of Service
23. 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
(AOB) Assignment of Benefits
Participating Provider
Treating or performing physician
Amblatory Care
24. A willful act by an employee of taking possession of an employer's money
etiquette
Embezzlement
(DOS) Date of Service
Protected health information
25. 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
nonprivileged information
(POS) Point-of Service Plan
(Non-par) Non-Participating Provider
Network
26. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
Treating or performing physician
(DRG's)
security officer
subscriber
27. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
hmo
(PAC) Pre- Admission Certification
deductible
ethics
28. 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
(DRG's)
Out of Network (OON)
Experimental Procedures
fraud
29. Any data that identify an individual and describes his or her health status - age - sex - ethnicity - or other demographic characteristics - whether or not that information is stored or transmitted electronically.
ppo
disclosure
Protected health information
authorization form
30. The maximum amount a plan pays for a covered service
claim
premium
Amblatory Care
Allowed Expenses
31. The transmission of information between two parties to carry out financial or administrative activities related to health care.
pos
transaction
complience
medical foundation
32. A clinic that is owned by the HMO and the physicians are employees of the HMO
Confidential communication
Resonable Charge
closed panel HMO
premium
33. 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
(UR) Utilization review
attending physician
Preauthorization
Notice of Privacy Practices
34. 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
Sub-acute Care
prepaid plan
Maximum Out Of Pocket
35. 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
Participating Provider
AMA
pos
Out of Network (OON)
36. 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
Pre-existing Condition Exclusion
Privacy officer
premium
(COB) Coordination of Benefits
37. Authorization given by a health plan for a Member to obtain services form a healthcare provider - most commonly required for hospital services
prepaid plan
Pre-certification
ethics
Network
38. Arrangement consisting of a group of providers who have a contract with an insurer - employer - third party administrator or other sponsoring group.
deductible
medical foundation
phantom billing
(EPO) Exclusive Provider Organization
39. Approval or consent by a primary physician for patient referral to ancillary services and specialists
privacy
Referral
Beneficiary
Notice of Privacy Practices
40. 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
Specialist
Privacy officer
clearinghouse
(DME) Durable Medical Equipment
41. 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
prepaid plan
confidentiality
electronic media
econdary Payer
42. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
e-health information management
phantom billing
Security Rule
privacy
43. A willful act by an employee of taking possession of an employer's money
security officer
(PEC) Pre-existing condition
self-referral
Embezzlement
44. Is the provider who renders a service to a patient
Treating or performing physician
Pre-existing Condition Exclusion
(DRG's)
medical foundation
45. 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
Amblatory Care
Maximum Out Of Pocket
authorization form
46. A patient claim is eligible for medicare and medicaid
Consent form
subscriber
(PPS) Hospital Impatient Prospective Payment System
crossover claim
47. The dates of healthcare services were provided to the beneficiary
Experimental Procedures
premium
(DOS) Date of Service
medical foundation
48. An individual designated ot help the provider remain in compliance by setting policies and procedures in place - and by training and managing the staff regarding HIPAA and patient rights; usually the contact person for questions and complaints.
Privacy officer
(DRG's)
consulting physician
abuse
49. 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
closed panel HMO
(ERISA) Employee Retirement Income Security Act of 1974
privacy
(COBRA)
50. 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.
ethics
(DCI) Duplicate Coverage Inquiry
state preemption
closed panel HMO