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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.
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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. Structural protein found in the skin and connective tissue
Disability insurance
Sebaceous glands
Collagen
Palatine bones
2. The fractured area of bone collapses on itself.
New patient
Dirty claim
Uncertain behavior
Compression fracture
3. Superior and widest bone
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Pelvis
Contracted Rates with MCOs
Lacrimal bones
4. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Sebaceous glands
Chapters
Spinal/Vertebral Column
5. Make up part of the interior of the nose.
Sebaceous glands
nonessential modifiers
Inferior nasal conchae
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
6. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Gender rule
Rib Cage
Lipocyte
Electronic Claim
7. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Birthday rule
Medigap (Medicare Supplemental Insurance)
Pre-paid Health Plan
Carcinoma (Ca) in situ
8. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Unauthorized benefit
Employee Liability
9. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Employee Liability
MEDICAID COVERAGE
eponychium
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
10. Structural protein found in the skin and connective tissue
Assault
Collagen
History
co-payment
11. 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.
Carcinoma (Ca) in situ
Inpatient
National Correct Coding Initiative (NCCI)
-99 - Multiple Modifiers
12. Numbers 1-7 - attach directly to the sternum in the front of the body.
Preferred Provider Organization (PPO)
true ribs
TRICARE
Ulcermembranes
13. 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
Collagen
Preferred Provider Organization (PPO)
Radius
Secondary malignancy
14. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Inferior nasal conchae
There are two types of sweat glands
Peer Review Organization (PRO)
Section 3 Index to External Causes of Injury (E codes)
15. 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
Fissure
-51 - Multiple Procedures
Assault
stand-alone codes
16. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
The St. Anthony Relative Value for Physicians (RVP)
Humerus
Liability insurance
Vomer
17. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve
encounter form
Comminuted fracture
Accident
eponychium
18. paired bones at the corner of each eye that cradle the tear ducts.
Blue Cross/Blue Shield Plans
Uncertain behavior
Lacrimal bones
Employer Liability
19. Make up part of the interior of the nose.
History of present illness (HPI)
-99 - Multiple Modifiers
Advance Beneficiary Notice
Inferior nasal conchae
20. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
The Current Procedural Terminology (CPT)
Gender rule
itemized statement
upper appendicular skeleton
21. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Physician
Primary malignancy
Complicated
Outpatient
22. The fractured area of bone collapses on itself.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Impetigo
nonessential modifiers
Compression fracture
23. 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
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Relative Value Payment Schedules Method
Sebaceous glands
TRICARE
24. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.
Pre-determination
bullet (a
Mutually Exclusive Edits
Reasons for Documentation
25. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
Malignant
appendicular skeleton .
Relative Value Payment Schedules Method
Workers Compensation
26. 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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27. Consists of the skull - rib cage - and spine
Compression fracture
axial skeleton
Nonparticipating physician
Malignant
28. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu
MEDICARE Part A
Neoplasm Table
Inpatient
Outpatient
29. 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
Eligibility
Pre-paid Health Plan
Medicare
Birthday rule
30. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
MEDICAID COVERAGE
New Patient
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Medical necessity
31. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Add-on codes
Alphabetic Index (Volume 2)
Melanin
TRICARE PLANS
32. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Category I Codes CPT
Health Maintenance Organization (HMO)
Albino
Wheal
33. 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.
National Correct Coding Initiative (NCCI)
Unauthorized benefit
ligaments
Suicide Attempt
34. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
The Good Samaritan Act
phalanges (phalanx.s)
Retention of Medical Records
TRICARE PLANS
35. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Albino
Coinsurance
Assault
Full ROM
36. Is one who has no contract with the health insurance plan.
Social Security Number
Nonparticipating physician
Vomer
Liability insurance
37. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Category III Codes CPT
Established patient
Hairline
Compliance Regulations
38. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Blue Cross/Blue Shield Plans
Mutually Exclusive Edits
-90 - Reference (Outside) Laboratory
Section 3 Index to External Causes of Injury (E codes)
39. requires investigation and needs further clarification.
Medically needy
Point-of-Service plan (POS)
encounter form
Rejected claim
40. The physician must obtain this number in order to practice within a state.
State License Number
Physician
Assault
nonessential modifiers
41. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Established patient
Category II Codes CPT
MEDICAID COVERAGE
Pathologic
42. Forms the sides of the cranium
Limited ROM
Birthday rule
Inferior nasal conchae
Parietal Bones
43. 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.
The Universal Claim Form
Carpals
-26 - Professional Component
lunula
44. 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.
Parietal Bones
Long bones
Non-covered benefit
A plus sign (+)
45. 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.
Electronic Claim
phalanges (phalanx.s)
lunula
Relative Value Payment Schedules Method
46. Any fracture occurring spontaneously as a result of disease.
No ROM
Hairline
Blue Cross/Blue Shield Plans
Pathologic
47. are small with irregular shapes. They are found in the wrist and ankle.
Short bones
Medicare Claim Status
Sebaceous glands
MEDICAID COVERAGE
48. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Health practitioner
Medically needy
ulna
Chief complaint (CC)
49. 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.
Zygoma
Unspecified nature
eponychium
False Claims Act (FCA)
50. 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
Impetigo
The Integumentary System
Salter-Harris
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