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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. 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.
Established Patient
Employee Liability
Unique Provider Identification Number (UPIN)
National Correct Coding Initiative (NCCI)
2. 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
Gender rule
Abuse
Fee Schedule
Outpatient
3. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Surgical Package
There are two types of sweat glands
CPT SECTIONS.
4. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Group Insurance
Participating physician
Medical necessity
Accept assignment
5. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Fiscal Intermediary
Medigap (Medicare Supplemental Insurance)
Wheal
-90 - Reference (Outside) Laboratory
6. 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.
Salter-Harris
Benign
Fissure
Non-covered benefit
7. 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
Commercial Carriers
Macule
MEDICARE Part B
Ethmoid Bone
8. 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
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Unlisted Procedures Procedures
appendicular skeleton .
Relative Value Payment Schedules Method
9. - 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
The Current Procedural Terminology (CPT)
Medigap (Medicare Supplemental Insurance)
Limited ROM
Category III Codes CPT
10. The moon like white area at the base of the nail.
Malignant
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Deductible
lunula
11. Lower portion of the pelvic bone
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Compression fracture
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Ischium
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....
Disability insurance
Eligibility
The St. Anthony Relative Value for Physicians (RVP)
Retention of Medical Records
13. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Two triangular symbols (a
Complicated
Comminuted fracture
Peer Review Organization (PRO)
14. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Consultation
Albino
Mutually Exclusive Edits
History
15. Are composed of three-digit codes representing a single disease or condition.
itemized statement
Categories
MEDICAID COVERAGE
Medicare
16. 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
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Pre-authorization
Location Methods
No ROM
17. anterior to the temporal bones.
Sphenoid Bones
Health Insurance Portability and Accountability Act (HIPAA)
Multigravida
Established patient
18. Number assigned by the insurance company to a physician who renders services to patients.
Fissure
Uncertain behavior
Provider Identification Number (PIN)
Complicated
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.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Unspecified (hypertension)
itemized statement
Coinsurance
20. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
Blue Cross/Blue Shield Plans
co-payment
MEDICARE Part B
Multigravida
21. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Chief complaint
Temporal Bone
Pre-paid Health Plan
Coding
22. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Zygoma
The Current Procedural Terminology (CPT)
-50 - Bilateral Procedure
Categorically needy -MEDICAID
23. 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.
Personal Insurance
Nodule
False Claims Act (FCA)
Inpatient
24. Produce secretions that allow the body to be moisturized or cooled.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Peer Review Organization (PRO)
Past - family and social history (PFSH)
-51 - Multiple Procedures
25. 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
A plus sign (+)
Pre-certification
Collagen
Electronic Claim
26. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Zygoma
Deductible
Category II Codes CPT
The Good Samaritan Act
27. poisoning was inflicted by another person with intent to kill or injure
Nonparticipating physician
Neoplasm Table
Pre-authorization
Assault
28. major skin pigment
Melanin
Unspecified (hypertension)
Nodule
Musculoskeletal System
29. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Medicare Claim Status
Pre-certification
Coordination of Benefits (COB)
Peer Review Organization (PRO)
30. Mild or controlled hypertension and no damage to the vascular system or organs.
Zygoma
Benign (hypertension)
appendicular skeleton .
Dirty claim
31. are small with irregular shapes. They are found in the wrist and ankle.
nonessential modifiers
Short bones
Contracted Rates with MCOs
New patient
32. 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....
Group practice
There are two types of sweat glands
Established patient
Surgical Package
33. Consists of the skull - rib cage - and spine
Contracted Rates with MCOs
Category III Codes CPT
Pathologic
axial skeleton
34. Upper jaw bone
Established patient
State License Number
Long bones
Maxilla
35. 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
Fiscal Intermediary
Disability insurance
Social Security Number
Blue Cross/Blue Shield Plans
36. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
Performing Provider Identification Number (PPIN)
Performing Provider Identification Number (PPIN)
Patient Confidentiality
Pelvis
37. requires investigation and needs further clarification.
Mutually Exclusive Edits
Rejected claim
Accept assignment
Long bones
38. 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
History of present illness (HPI)
Established Patient
Blue Cross/Blue Shield Plans
39. Is an electronic or paper-based report of payment sent by the payer to the provider.
Remittance Advice
Consultation
Compliance Regulations
Rib Cage
40. 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.
The Current Procedural Terminology (CPT)
Inpatient
Fissure
Eligibility
41. Is the lower medial arm bone.
ulna
Health Insurance Portability and Accountability Act (HIPAA)
Pre-authorization
Category II Codes CPT
42. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
ligaments
Sub classification
Compliance Regulations
43. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Comminuted fracture
MEDICARE Part C
MEDICARE Part A
Capitated Rates
44. Upper jaw bone
Health Maintenance Organization (HMO)
Section 3 Index to External Causes of Injury (E codes)
Maxilla
Colles
45. 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).
Chapters
Frontal Bone
Sphenoid Bones
Sections
46. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Section 3 Index to External Causes of Injury (E codes)
Mutually Exclusive Edits
Radius
Unspecified nature
47. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
History of present illness (HPI)
circle with a line through it)
Medicare
Unspecified nature
48. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Civil Monetary Penalties Law (CMPL)
Medically needy
Performing Provider Identification Number (PPIN)
Accept assignment
49. Forms the anterior part of the skull and the forehead
Frontal Bone
Parietal Bones
ligaments
State License Number
50. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
sebaceous(oil) glands and the suddoriferous (sweat) glands
Medical Records
Retention of Medical Records
Musculoskeletal System