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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. 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.
TRICARE
-32 - Mandated Services
Sebaceous glands
False Claims Act (FCA)
2. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
Performing Provider Identification Number (PPIN)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Complicated
Liability insurance
3. anterior to the temporal bones.
Sphenoid Bones
ulna
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Full ROM
4. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
Short bones
Musculoskeletal System
MEDICAID COVERAGE
5. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Advance Beneficiary Notice
Pelvis
Fiscal Intermediary
Spinal/Vertebral Column
6. 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.
Evaluation and Management Review
Dirty claim
Coordination of Benefits (COB)
Multigravida
7. This is the inventory of the constitutional symptoms regarding the various body systems.
Paper Claim
Ischium
Review of Systems (ROS)
Chief complaint
8. 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
Deductible
TRICARE PLANS
Unspecified nature
Spinal/Vertebral Column
9. This is a set of information the physician gathers from the patient regarding the following:
Nonparticipating physician
History
Palatine bones
Employer Identification Number (EIN)
10. - 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
Section 3 Index to External Causes of Injury (E codes)
Medigap (Medicare Supplemental Insurance)
Established patient
State License Number
11. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Pre-authorization
Secondary malignancy
Medically needy
Medigap (Medicare Supplemental Insurance)
12. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Tabular List (Volume 1)...
Medigap (Medicare Supplemental Insurance)
Medicaid
Mutually Exclusive Edits
13. 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
Subcategories
upper appendicular skeleton
Musculoskeletal System
The Patient Care Partnership (Patient's Bill of Rights)
14. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Ethmoid Bone
Flat bones
Capitated Rates
Frontal Bone
15. forms the roof of the nasal cavity.
Ethmoid Bone
Category II Codes CPT
Retention of Medical Records
Pre-determination
16. - 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
Pre-authorization
MEDICARE Part A
Medigap (Medicare Supplemental Insurance)
Nodule
17. This is the inventory of the constitutional symptoms regarding the various body systems.
Ischium
The Patient Care Partnership (Patient's Bill of Rights)
Review of Systems (ROS)
Vomer
18. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Category II Codes CPT
Occipital Bone
Collagen
Participating physician
19. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
Provider Identification Number (PIN)
Abuse
Disability insurance
itemized statement
20. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
Participating physician
Malignant
Medicaid
Multigravida
21. 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
Medicare
sprain
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Radius
22. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Medical necessity
Unspecified (hypertension)
Electronic Claim
23. 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
Physician
Impacted
Ethmoid Bone
Health Care Financing Administration Common Procedure Coding System
24. Groove or crack like sore
Established Patient
appendicular skeleton .
Palatine bones
Fissure
25. 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
Hairline
Colles
Preferred Provider Organization (PPO)
26. 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.
Ulcermembranes
Medicare Claim Status
State License Number
upper appendicular skeleton
27. 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.
Established Patient
Modifiers
phalanges (phalanx.s)
MEDICARE Part C
28. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.
The Good Samaritan Act
Review of Systems (ROS)
Preferred Provider plan
Radius
29. 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)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Point-of-Service plan (POS)
HCPCS Level II codes (National Codes)
30. The physician must obtain this number in order to practice within a state.
Zygoma
State License Number
Pre-paid Health Plan
Social Security Number
31. major skin pigment
Fee-for-Service
Dirty claim
Unspecified nature
Melanin
32. 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
Spinal/Vertebral Column
Lacrimal bones
Health Insurance Portability and Accountability Act (HIPAA)
eponychium
33. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Location Methods
Medically needy
Participating physician
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
34. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Keratin
Ischium
Category II Codes CPT
Parietal Bones
35. Upper jaw bone
Maxilla
Inpatient
Performing Provider Identification Number (PPIN)
appendicular skeleton .
36. numbers 8-10 - are attached to the sternum by cartilage
Section 3 Index to External Causes of Injury (E codes)
False ribs
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Neoplasm Table
37. 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.
Section 3 Index to External Causes of Injury (E codes)
axial skeleton
Malignant
Inpatient
38. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
Musculoskeletal System
Patient Confidentiality
stand-alone codes
HCPCS Level II codes (National Codes)
39. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Employer Liability
Frontal Bone
Indemnity Insurance
sprain
40. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
Fee-for-Service
Salter-Harris
appendicular skeleton .
41. 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
Past - family and social history (PFSH)
Invalid claim
Performing Provider Identification Number (PPIN)
Commercial Carriers
42. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
itemized statement
Macule
Medigap (Medicare Supplemental Insurance)
Categories
43. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Abuse
Unlisted Procedures Procedures
Multigravida
Mutually Exclusive Edits
44. The cuticle at the lower part of the nail and this is sometimes referred to as the
Group Provider Number
eponychium
Sebaceous glands
Uncertain behavior
45. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Carcinoma (Ca) in situ
Medically needy
Mutually Exclusive Edits
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
46. Number assigned to the physician by Medicare program.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Chief complaint
Unique Provider Identification Number (UPIN)
Medicare Claim Status
47. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Fee Schedule
Category I Codes CPT
Complicated
MEDICARE Part B
48. 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
Limited ROM
New Patient
Fee Schedule
Short bones
49. 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
The Patient Care Partnership (Patient's Bill of Rights)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Health Maintenance Organization (HMO)
Accident
50. Numbers 1-7 - attach directly to the sternum in the front of the body.
Add-on codes
Sphenoid Bones
true ribs
MEDICARE Part A