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Test your basic knowledge |
Medical Billing And Coding 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.
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. 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
Health Care Financing Administration Common Procedure Coding System
Health Care Financing Administration Common Procedure Coding System
Location Methods
eponychium
2. The reason the patient came to see the physician.
Chief complaint (CC)
Sebaceous glands
-26 - Professional Component
False ribs
3. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Performing Provider Identification Number (PPIN)
Limited ROM
Accept assignment
Medically needy
4. Consists of the skull - rib cage - and spine
New patient
Sebaceous glands
Malignant
axial skeleton
5. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu
essential modifiers
Blue Cross/Blue Shield Plans
Salter-Harris
Secondary malignancy
6. Is an electronic or paper-based report of payment sent by the payer to the provider.
Past - family and social history (PFSH)
Established patient
Melanin
Remittance Advice
7. Further classified as to primary - secondary - or carcinoma in situ.
Malignant
Pre-certification
Hairline
Paper Claim
8. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
False ribs
Capitated Rates
Employer Identification Number (EIN)
Medicare
9. major skin pigment
Melanin
Commercial Carriers
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Sebaceous glands
10. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
HCPCS Level I codes
Colles
Nonparticipating physician
11. Benign growth extending from the surface of the mucous membrane
Workers Compensation
Point-of-Service plan (POS)
Polyp
-50 - Bilateral Procedure
12. Are composed of three-digit codes representing a single disease or condition.
Subcategories
Categories
Suicide Attempt
MEDICAID COVERAGE
13. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
Unique Provider Identification Number (UPIN)
Preferred Provider plan
False Claims Act (FCA)
Compliance Regulations
14. 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
Ischium
Surgical Package
State License Number
Liability insurance
15. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
Gender rule
Outpatient
Rejected claim
-32 - Mandated Services
16. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
The Patient Care Partnership (Patient's Bill of Rights)
Sebaceous glands
phalanges (phalanx.s)
Category I Codes CPT
17. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
sprain
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Spinal/Vertebral Column
18. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Comminuted fracture
Remittance Advice
Ulcermembranes
Accept assignment
19. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.
MEDICARE Part B
Pubic bone
phalanges (phalanx.s)
Dirty claim
20. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
stand-alone codes
phalanges (phalanx.s)
Tabular List (Volume 1)...
Neoplasm Table
21. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
Pre-certification
Electronic Claim
Non-covered benefit
Wheal
22. 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:
Hypertension Table
Pre-authorization
Advance Beneficiary Notice
Parietal Bones
23. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Peer Review Organization (PRO)
Inpatient
Non-covered benefit
premium
24. most synarthroses are immovable joints held together by fibrous tissue.
co-payment
Vesicle
Collagen
No ROM
25. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
False Claims Act (FCA)
-90 - Reference (Outside) Laboratory
Albino
Medigap (Medicare Supplemental Insurance)
26. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
Unauthorized benefit
The Current Procedural Terminology (CPT)
Unlisted Procedures Procedures
27. The poisoning was self-inflicted.
true ribs
Health practitioner
Sections
Suicide Attempt
28. The main term in the index may by followed by terms within parenthesis.
-99 - Multiple Modifiers
Eligibility
Alphabetic Index (Volume 2)
Benign (hypertension)
29. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Unspecified (hypertension)
Preferred Provider Organization (PPO)
Employer Identification Number (EIN)
30. The lower anterior part of the bone
Pubic bone
Ethmoid Bone
Health Insurance Portability and Accountability Act (HIPAA)
Mutually Exclusive Edits
31. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Two triangular symbols (a
Medicare Claim Status
Ethmoid Bone
Clearinghouse
32. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
Keratin
National Correct Coding Initiative (NCCI)
Chief complaint (CC)
The Integumentary System
33. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Macule
TRICARE PLANS
Melanin
34. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
sprain
appendicular skeleton .
Primary malignancy
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
35. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
Preferred Provider plan
The St. Anthony Relative Value for Physicians (RVP)
Category II Codes CPT
Invalid claim
36. Most billing-related cases are based on HIPAA and False Claims Act.
Rib Cage
Occipital Bone
Sesamoid bones
Compliance Regulations
37. The fractured area of bone collapses on itself.
Assault
No ROM
Compression fracture
Past - family and social history (PFSH)
38. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
lunula
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Health Care Financing Administration Common Procedure Coding System
Assault
39. Forms the anterior part of the skull and the forehead
Location Methods
Mandible
Frontal Bone
Sebaceous glands
40. Absence of hair from areas where it normally grows
Coordination of Benefits (COB)
Fee-for-Service
Alopecia
Past - family and social history (PFSH)
41. Typically not used on the claim form unless the provider does not have an EIN.
Invalid claim
Civil Monetary Penalties Law (CMPL)
Social Security Number
Rib Cage
42. 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
Past - family and social history (PFSH)
stand-alone codes
Colles
HCPCS Level I codes
43. The lower anterior part of the bone
Unauthorized benefit
bullet (a
Blue Cross/Blue Shield Plans
Pubic bone
44. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
Uncertain behavior
Remittance Advice
Secondary malignancy
Employer Liability
45. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
History of present illness (HPI)
Collagen
Employer Liability
Deductible
46. The cuticle at the lower part of the nail and this is sometimes referred to as the
Birthday rule
Categories
Albino
eponychium
47. 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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48. make up part of the roof of the mouth
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Palatine bones
Suicide Attempt
The St. Anthony Relative Value for Physicians (RVP)
49. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
stand-alone codes
Health Care Financing Administration Common Procedure Coding System
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Macule
50. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Clean claim
Employer Identification Number (EIN)
phalanges (phalanx.s)
-50 - Bilateral Procedure