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Test your basic knowledge |
Medical Coding And Billing Clinical Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Sub-acute Care
Beneficiary
Standard
2. 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.
(ERISA) Employee Retirement Income Security Act of 1974
security officer
disclosure
Claim
3. Customs - rules of conduct - courtesy - and manners of the medical profession
(APC) Ambulatory Patient Classifications
Out of Network (OON)
Deductible
etiquette
4. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
(UCR) Usual - Customary and Reasonable
IIHI
abuse
Coordinated Coverage
5. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
Supplementary Medical Insurance
ee schedule
referring physician
e-health information management
6. A monthly fee paid by the insured for specific medical insurance coverage
premium
Claim
econdary Payer
(UCR) Usual - Customary and Reasonable
7. The maximum amount a plan pays for a covered service
deductible
electronic media
Consent form
Allowed Expenses
8. 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
Consent form
Protected health information
deductible
9. 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
AMA
ee schedule
Covered Expenses
authorization form
10. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
security officer
(AOB) Assignment of Benefits
privacy
clearinghouse
11. Any medical condition that has been diagnosed or treated within a specified period immediately preceding the covered person's effective date of coverage
(PEC) Pre-existing condition
Sub-acute Care
Amblatory Care
Covered Expenses
12. 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.
Deductible
(PCN) Primary Care Network
Treating or performing physician
state preemption
13. 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)
cash flow
Medigap Insurance
electronic media
14. 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
hmo
(DME) Durable Medical Equipment
crossover claim
nonprivileged information
15. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
abuse
IIHI
(PCP) Primary Care Physician
Specialist
16. Medicare's method of paying acute care hospitals for inpatient care
Specialist
covered entity
(PPS) Hospital Impatient Prospective Payment System
Subscriber
17. The condition of being secluded from the presence or view of others.
Embezzlement
Notice of Privacy Practices
privacy
Referral
18. Standards of conduct generally accepted as a moral guide for behavior.
complience
cash flow
ethics
(TPA) Third Party Administrator
19. 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
(COBRA)
deductible
Open Enrollment
Consent form
20. A review of the need for inpatient hospital care - completed before the actual admission
e-health information management
(PAC) Pre- Admission Certification
preauthorization
epo
21. Medical services provided on an outpatient basis
Amblatory Care
transaction
Covered Expenses
ppo
22. 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
(EPO) Exclusive Provider Organization
Open Enrollment
self-referral
(DRG's)
23. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(POS) Point-of Service Plan
IIHI
consulting physician
Maximum Out Of Pocket
24. Incidents or practices - not usually considered fraudulent - that are inconsistent with accepted sound medical business or fiscal practices.
Privileged information
abuse
Open Enrollment
(DCI) Duplicate Coverage Inquiry
25. A provision that apples when a person is covered under more than one group medical program
privacy
(ABN) Advance Beneficiary Notice
(COB) Coordination of Benefits
Embezzlement
26. Privately purchased individual or group health insurance policies designed to supplement Medicare coverage
Maximum Out Of Pocket
confidentiality
Medigap Insurance
Subscriber
27. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
(Non-par) Non-Participating Provider
Beneficiary
(PCN) Primary Care Network
subscriber
28. A notice to the insurance company that a person received care covered by the plan. A claim is also a request for payment
econdary Payer
Out of Network (OON)
Privacy officer
Claim
29. 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.
Deductible
(TPA) Third Party Administrator
Privacy officer
e-health information management
30. A patient claim is eligible for medicare and medicaid
claim
crossover claim
(ERISA) Employee Retirement Income Security Act of 1974
medical foundation
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
Network
(APC) Ambulatory Patient Classifications
clearinghouse
ppo
32. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
electronic media
crossover claim
(Non-par) Non-Participating Provider
(PEC) Pre-existing condition
33. 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)
(DRG's)
Treating or performing physician
attending physician
Consent form
34. A process of meeting regulations - recommendations - and expectations of federal and state agencies that pay for health care services and regulate the industry
complience
Protected health information
Claim
Notice of Privacy Practices
35. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
(APC) Ambulatory Patient Classifications
deductible
authorization form
claim
36. 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
(ABN) Advance Beneficiary Notice
abuse
pos
nonprivileged information
37. What the insurance company will consider paying for as defined in the contract.
AMA
referral
Covered Expenses
ids
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
(ABN) Advance Beneficiary Notice
Pre-existing Condition Exclusion
Participating Provider
business associate
39. 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)
open panel HMO
covered entity
hmo
Consent form
40. The hospital classification and reimbursement system that groups patients by diagnosis - surgical procedures - age - sex and presence of complications.
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41. 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
ethics
open panel HMO
covered entity
subscriber
42. 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
(EPO) Exclusive Provider Organization
Experimental Procedures
(TPA) Third Party Administrator
disclosure
43. A managed care plan in which a range of health care services are made available to plan members for a predetermined fee per member
hmo
medical foundation
claim
Participating Provider
44. 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
(Non-par) Non-Participating Provider
abuse
premium
45. The person responsible for payment of premiums or whose employment is the basis for eligibility for membership in an HMO or other health plan
electronic media
(PAC) Pre- Admission Certification
Subscriber
(Non-par) Non-Participating Provider
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
(ERISA) Employee Retirement Income Security Act of 1974
Beneficiary
privacy
Deductible
47. The amount of actual money available to the medical practice
(UR) Utilization review
cash flow
complience
(Non-par) Non-Participating Provider
48. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Subscriber
benefit period
referring physician
deductible
49. 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.
Pre-existing Condition Exclusion
Beneficiary
Claim
health care provider
50. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
benefit period
(Non-par) Non-Participating Provider
(UCR) Usual - Customary and Reasonable
(COB) Coordination of Benefits
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