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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. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
crossover claim
state preemption
HIPAA
complience plan
2. The release - transfer - provision of access to - or divulging in any other manner of information outside the entity holding the information.
Embezzlement
deductible
disclosure
security officer
3. Standards of conduct generally accepted as a moral guide for behavior.
e-health information management
ethics
Pre-certification
Amblatory Care
4. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
(PPS) Hospital Impatient Prospective Payment System
consulting physician
premium
Confidential communication
5. 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
pcp
(EPO) Exclusive Provider Organization
cash flow
Security Rule
6. A provision that apples when a person is covered under more than one group medical program
(COB) Coordination of Benefits
Sub-acute Care
Specialist
econdary Payer
7. 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
covered entity
(TPA) Third Party Administrator
benefit period
fraud
8. The mode of electronic transmission (e.g. Internet - extranet - leased phone or dial-up phone lines - fax modems).
fraud
electronic media
(DCI) Duplicate Coverage Inquiry
attending physician
9. 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
Deductible
(DCI) Duplicate Coverage Inquiry
(UR) Utilization review
referring physician
10. Medical staff member who is legally responsible for the care and treatment given to a patient.
(PPS) Hospital Impatient Prospective Payment System
ethics
consent
attending physician
11. The portion of payments for covered health services required to be paid by the patient - including co-payments - co-insurance and deductible
(PCN) Primary Care Network
(OOPs) Out of Pocket Costs/Expenses
Out of Network (OON)
Covered Expenses
12. 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.
Protected health information
Security Rule
breach of confidential communication
closed panel HMO
13. A physician who is part of am managed care plan that provides all primary health care services to members of the plan
ppo
Out of Network (OON)
pcp
IIHI
14. The amount of actual money available to the medical practice
ppo
cash flow
crossover claim
(PCP) Primary Care Physician
15. A patient claim is eligible for medicare and medicaid
Treating or performing physician
crossover claim
(DME) Durable Medical Equipment
claim
16. 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
(ERISA) Employee Retirement Income Security Act of 1974
referral
(ABN) Advance Beneficiary Notice
complience plan
17. 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
(ERISA) Employee Retirement Income Security Act of 1974
(ABN) Advance Beneficiary Notice
business associate
consent
18. Customs - rules of conduct - courtesy - and manners of the medical profession
covered entity
hmo
etiquette
referral
19. An organization of provider sites with a contracted relationship that offer services
ids
prepaid plan
consulting physician
complience plan
20. The state of treating privately or secretly - and not disclosing to other individuals or for public knowledge - the patient's conversations or medical records.
(TPA) Third Party Administrator
prepaid plan
disclosure
confidentiality
21. Customs - rules of conduct - courtesy - and manners of the medical profession
(PCP) Primary Care Physician
etiquette
epo
(TPA) Third Party Administrator
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.
(PEC) Pre-existing condition
Privacy officer
attending physician
clearinghouse
23. A term used to refer to the commonly charged or prevailing fees for health services within a geographic area
ids
clearinghouse
health care provider
(UCR) Usual - Customary and Reasonable
24. 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.
referral
(DME) Durable Medical Equipment
Open Enrollment
business associate
25. 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
referring physician
Protected health information
ppo
Sub-acute Care
26. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
prepaid plan
subscriber
attending physician
Standard
27. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
(DCI) Duplicate Coverage Inquiry
consent
referral
open panel HMO
28. An authorization directing the insurer to make payment directly to a provider of benefits - such as a physician or dentist - rather than to the insured
(AOB) Assignment of Benefits
Open Enrollment
Privileged information
Covered Expenses
29. 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
transaction
Deductible
Confidential communication
Pre-existing Condition Exclusion
30. Prior approval from a health care plan administrator to receive reimbursement for surgery and other procedures to be performed
preauthorization
health care provider
Pre-certification
Claim
31. A sum of money that must be paid by the patient before the insurance plan pays benefits for services rendered
Medigap Insurance
complience plan
deductible
closed panel HMO
32. A monthly fee paid by the insured for specific medical insurance coverage
clearinghouse
(OOPs) Out of Pocket Costs/Expenses
premium
Embezzlement
33. A management plan composed of policies and procedures to accomplish uniformity - consistency - and conformity in medical record keeping that fulfills offical requirements.
Treating or performing physician
complience plan
Out of Network (OON)
benefit period
34. A health insurance enrollee chooses to see an out of network provider without authorization
self-referral
Coordinated Coverage
AMA
claim
35. An insurance policy - plan - or program thay pays second on a claim for medical care. For children covered under two insurance plans - primary coverage will be determined by the Subscriber (mom and dad) whose month of birth is closest to the beginnin
Resonable Charge
Assignment & Authorization
econdary Payer
etiquette
36. Physicians - hospitals and other healthcare providers that an HMO - PPO or other managed care network has selected to provide care for its members
Allowed Expenses
Consent form
Network
pcp
37. A request to an insurance company or group medical plan by another inusrance company or medical plan to find out whether other coverage exists
Pre-certification
epo
(PEC) Pre-existing condition
(DCI) Duplicate Coverage Inquiry
38. Unauthorized release of information
breach of confidential communication
(DCI) Duplicate Coverage Inquiry
HIPAA
(AOB) Assignment of Benefits
39. A rule - condition - or requirement
Preauthorization
Standard
econdary Payer
IIHI
40. The member who holds an insurance policy providing medical coverage in return for a fixed monthly fee
subscriber
(DOS) Date of Service
ppo
attending physician
41. Integrating benefits payable under more than one health insurance.
etiquette
(POS) Point-of Service Plan
clearinghouse
Coordinated Coverage
42. American Medical Association
Assignment & Authorization
pos
AMA
benefit period
43. A nonprofit integrated delivery system
state preemption
Standard
medical foundation
Experimental Procedures
44. Is the individual directing the selection - preparation - or administration of tests - medication - or treatment
preauthorization
ordering physician
(PCP) Primary Care Physician
ids
45. A review of the need for inpatient hospital care - completed before the actual admission
Consent form
Privileged information
hmo
(PAC) Pre- Admission Certification
46. A provider whose opinion or advice about evaluation or management of a specific problem is requested by another physician
consulting physician
Medigap Insurance
Supplementary Medical Insurance
covered entity
47. Any and all transations in which health care information is accessed - processed - stored - and transferred using electronic technologies.
complience plan
Specialist
(DCI) Duplicate Coverage Inquiry
e-health information management
48. Verbal or written agreement that gives approval to some action - situation - or statement.
(PAC) Pre- Admission Certification
Protected health information
Amblatory Care
consent
49. Is the provider who renders a service to a patient
Security Rule
Covered Expenses
Treating or performing physician
premium
50. An independent organization that receives insurance claims from the physician's office - performs software edits - and redistributes the claims electronically to various insurance carriers.
(TPA) Third Party Administrator
Resonable Charge
clearinghouse
closed panel HMO