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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. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Lacrimal bones
Section 3 Index to External Causes of Injury (E codes)
-32 - Mandated Services
Remittance Advice
2. 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
Pelvis
Electronic Claim
Fraud
Sesamoid bones
3. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Unlisted Procedures Procedures
Sebaceous glands
encounter form
Accept assignment
4. Groove or crack like sore
Tabular List (Volume 1)...
Birthday rule
Fissure
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
5. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Parietal Bones
The Good Samaritan Act
Health practitioner
Greenstick
6. Cheekbone
ligaments
Zygoma
Reasons for Documentation
Explanation of Benefits (EOB)
7. uncertain whether benign or malignant; borderline malignancy
Uncertain behavior
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Deductible
Indemnity Insurance
8. 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
Blue Cross/Blue Shield Plans
Deductible
Peer Review Organization (PRO)
Chapters
9. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
axial skeleton
Non-covered benefit
Salter-Harris
Fraud
10. 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
-99 - Multiple Modifiers
The St. Anthony Relative Value for Physicians (RVP)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Medicare
11. 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'.
History
Subcategories
Pre-authorization
circle with a line through it)
12. 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....
Neoplasm Table
Exclusions and Limitations
Neoplasm Table
The St. Anthony Relative Value for Physicians (RVP)
13. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.
False ribs
Chief complaint
Inpatient
Keratin
14. 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
Eligibility
Relative Value Payment Schedules Method
Pre-determination
Employer Identification Number (EIN)
15. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Medical necessity
Fissure
Clearinghouse
Group practice
16. This is the inventory of the constitutional symptoms regarding the various body systems.
Mutually Exclusive Edits
Review of Systems (ROS)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Evaluation and Management Review
17. is a traumatic injury to a joint involving the soft tissue.
Location Methods
Employer Liability
Rib Cage
sprain
18. Is the upper arm bone.
appendicular skeleton .
Accept assignment
Humerus
Workers Compensation
19. This is not specified as benign or malignant in the diagnosis or medical record.
circle with a line through it)
Unspecified nature
Unspecified (hypertension)
Zygoma
20. Deficient in pigment (melanin)
Albino
Suicide Attempt
triangle (a
Review of Systems (ROS)
21. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Sphenoid Bones
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
circle with a line through it)
Full ROM
22. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Preferred Provider plan
-90 - Reference (Outside) Laboratory
Fee-for-Service
Health Insurance Portability and Accountability Act (HIPAA)
23. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Surgical Package
Advance Beneficiary Notice
Unlisted Procedures Procedures
Wheal
24. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Category II Codes CPT
Birthday rule
Pubic bone
Accept assignment
25. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).
Subcategories
Pathologic
Liability insurance
Sections
26. most synarthroses are immovable joints held together by fibrous tissue.
Alphabetic Index (Volume 2)
Remittance Advice
Paper Claim
No ROM
27. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
Social Security Number
Past - family and social history (PFSH)
Evaluation and Management Review
Explanation of Benefits (EOB)
28. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Complicated
Commercial Carriers
Patient Confidentiality
Polyp
29. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Accident
Pelvis
Chief complaint
Health Insurance Portability and Accountability Act (HIPAA)
30. Mild or controlled hypertension and no damage to the vascular system or organs.
Suicide Attempt
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Benign (hypertension)
Health Insurance Portability and Accountability Act (HIPAA)
31. Is a working diagnosis which is not yet established.
Blue Cross/Blue Shield Plans
Medicaid
Frontal Bone
Qualified diagnosis
32. 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).
Temporal Bone
Sebaceous glands
Chapters
Civil Monetary Penalties Law (CMPL)
33. Is the qualifying factor or factors that must be met before a patient receives benefits.
Review of Systems (ROS)
Nodule
Eligibility
Retention of Medical Records
34. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Vesicle
Parietal Bones
Medicare
Sub classification
35. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Hairline
Provider Identification Number (PIN)
Multigravida
There are two types of sweat glands
36. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
ligaments
Evaluation and Management Review
sprain
Polyp
37. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual
Fee Schedule
Paper Claim
Established patient
Pre-authorization
38. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
Established Patient
Health practitioner
Review of Systems (ROS)
upper appendicular skeleton
39. The reason the patient came to see the physician.
Assault
Pathologic
MEDICARE Part B
Chief complaint (CC)
40. Deficient in pigment (melanin)
Indemnity Insurance
Albino
Carpals
Unlisted Procedures Procedures
41. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
HCPCS Level I codes
phalanges (phalanx.s)
Polyp
Section 3 Index to External Causes of Injury (E codes)
42. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Suicide Attempt
Accident
Zygoma
Category III Codes CPT
43. 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.
true ribs
Medicare Claim Status
Fraud
Personal Insurance
44. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Inpatient
Pre-authorization
ulna
45. death of tissue associated with loss of blood supply
Gangrene
Coinsurance
Accident
Retention of Medical Records
46. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
nonessential modifiers
Subcategories
Unlisted Procedures Procedures
The St. Anthony Relative Value for Physicians (RVP)
47. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Sub classification
Location Methods
upper appendicular skeleton
48. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.
Two triangular symbols (a
Categories
Categorically needy -MEDICAID
Retention of Medical Records
49. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
ligaments
Participating physician
co-payment
HCPCS Level I codes
50. 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
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Capitated Rates
The Current Procedural Terminology (CPT)
Tabular List (Volume 1)...