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Test your basic knowledge |
Medical Billing And Coding Vocab
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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. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Invalid claim
Colles
encounter form
Peer Review Organization (PRO)
2. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran
Assault
Clearinghouse
true ribs
Preferred Provider Organization (PPO)
3. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages
Liability insurance
Sections
Consultation
Employer Liability
4. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
Preferred Provider Organization (PPO)
Advance Beneficiary Notice
Unique Provider Identification Number (UPIN)
Peer Review Organization (PRO)
5. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.
Employer Liability
Sphenoid Bones
Physician
Limited ROM
6. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi
State License Number
Suicide Attempt
Provider Identification Number (PIN)
Health Maintenance Organization (HMO)
7. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
eponychium
Workers Compensation
Advance Beneficiary Notice
premium
8. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Ischium
Albino
Abuse
9. Is the lateral lower arm bone (in line with the thumb).
Employer Liability
Column 1/Column 2 (previously called Comprehensive/Component) Edits
History
Radius
10. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
Assault
Undetermined
Paper Claim
Health Care Financing Administration Common Procedure Coding System
11. is defined as one who has not received any medical services within the last three years.
New Patient
phalanges (phalanx.s)
Exclusions and Limitations
lunula
12. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Medigap (Medicare Supplemental Insurance)
triangle (a
Workers Compensation
13. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.
Pre-authorization
Medically needy
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Unspecified nature
14. numbers 8-10 - are attached to the sternum by cartilage
National Correct Coding Initiative (NCCI)
False ribs
Carcinoma (Ca) in situ
Outpatient
15. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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16. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
New patient
-90 - Reference (Outside) Laboratory
Vesicle
Multigravida
17. Is made up of the shoulder - collar - pelvic and arms and legs
sprain
Compression fracture
appendicular skeleton .
Preferred Provider Organization (PPO)
18. Is the qualifying factor or factors that must be met before a patient receives benefits.
Vomer
Capitated Rates
History
Eligibility
19. anterior to the temporal bones.
Pre-determination
Location Methods
Group Insurance
Sphenoid Bones
20. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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21. Further classified as to primary - secondary - or carcinoma in situ.
Preferred Provider Organization (PPO)
Capitated Rates
Malignant
Section 3 Index to External Causes of Injury (E codes)
22. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Review of Systems (ROS)
Albino
The Integumentary System
Group practice
23. Are composed of three-digit codes representing a single disease or condition.
Categories
-50 - Bilateral Procedure
Maxilla
Patient Confidentiality
24. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
MEDICARE Part C
Review of Systems (ROS)
upper appendicular skeleton
Explanation of Benefits (EOB)
25. paired bones at the corner of each eye that cradle the tear ducts.
Categories
Lacrimal bones
Wheal
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
26. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Assault
Disability insurance
Hypertension Table
27. Number assigned to the physician by Medicare program.
Accept assignment
Unique Provider Identification Number (UPIN)
Clean claim
Categorically needy -MEDICAID
28. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Evaluation and Management Review
Rejected claim
Secondary malignancy
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
29. Upper jaw bone
eponychium
Maxilla
Musculoskeletal System
-90 - Reference (Outside) Laboratory
30. The reason the patient came to see the physician.
Explanation of Benefits (EOB)
National Correct Coding Initiative (NCCI)
Chief complaint (CC)
Rejected claim
31. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
Zygoma
Comminuted fracture
Fee Schedule
32. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features
The St. Anthony Relative Value for Physicians (RVP)
Alphabetic Index (Volume 2)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Electronic Claim
33. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Modifiers
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Vomer
TRICARE PLANS
34. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Flat bones
co-payment
-50 - Bilateral Procedure
Tabular List (Volume 1)...
35. Noninvasive - non-spreading - nonmalignant
Benign
Evaluation and Management Review
Column 1/Column 2 (previously called Comprehensive/Component) Edits
TRICARE PLANS
36. Deficient in pigment (melanin)
Carpals
Mutually Exclusive Edits
Albino
Medical necessity
37. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Abuse
Flat bones
Suicide Attempt
Colles
38. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Pre-certification
Mandible
triangle (a
ligaments
39. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features
Parietal Bones
Multigravida
Coding
Electronic Claim
40. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Deductible
Location Methods
Sebaceous glands
Personal Insurance
41. Represent changes in the text or definition between the triangles.
Sesamoid bones
Lipocyte
essential modifiers
Two triangular symbols (a
42. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Gender rule
Gender rule
Past - family and social history (PFSH)
Comminuted fracture
43. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Preferred Provider Organization (PPO)
Clearinghouse
Category III Codes CPT
Birthday rule
44. This modifier is used when the same procedure is performed on a mirror-image part of the body..
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
-50 - Bilateral Procedure
Nodule
A plus sign (+)
45. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
stand-alone codes
MEDICARE Part C
-99 - Multiple Modifiers
Compliance Regulations
46. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
Nonparticipating physician
Tabular List (Volume 1)...
-26 - Professional Component
Mutually Exclusive Edits
47. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
co-payment
-50 - Bilateral Procedure
The Good Samaritan Act
Contracted Rates with MCOs
48. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
New Patient
Personal Insurance
Pre-certification
Coding
49. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
TRICARE PLANS
Chapters
Carcinoma (Ca) in situ
There are three layers to the skin
50. The poisoning was self-inflicted.
Employer Liability
Suicide Attempt
encounter form
Unspecified nature