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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. anterior to the temporal bones.
Complicated
Fraud
itemized statement
Sphenoid Bones
2. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Health Insurance Portability and Accountability Act (HIPAA)
Preferred Provider Organization (PPO)
New Patient
3. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
Clearinghouse
essential modifiers
Preferred Provider plan
Capitated Rates
4. Is the qualifying factor or factors that must be met before a patient receives benefits.
Social Security Number
Gender rule
Eligibility
Undetermined
5. .. lower jaw bone.
MEDICARE Part C
Musculoskeletal System
Mandible
Nodule
6. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
MEDICARE Part C
Nodule
Unauthorized benefit
Surgical Package
7. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
Colles
Invalid claim
A plus sign (+)
The Integumentary System
8. A fat cell
Lipocyte
Malignant
Established Patient
MEDICARE Part D
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
Point-of-Service plan (POS)
Spinal/Vertebral Column
Fraud
Pre-paid Health Plan
10. Is a working diagnosis which is not yet established.
Health Care Financing Administration Common Procedure Coding System
Pre-determination
Modifiers
Qualified diagnosis
11. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Vomer
Preferred Provider Organization (PPO)
Retention of Medical Records
Chief complaint
12. 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
Section 3 Index to External Causes of Injury (E codes)
true ribs
Categories
Evaluation and Management Review
13. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Sections
Point-of-Service plan (POS)
Carcinoma (Ca) in situ
Vesicle
14. forms the roof of the nasal cavity.
Ethmoid Bone
History of present illness (HPI)
co-payment
Greenstick
15. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Performing Provider Identification Number (PPIN)
No ROM
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Palatine bones
16. 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.
History
Gangrene
itemized statement
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
17. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Rib Cage
Reasons for Documentation
Section 3 Index to External Causes of Injury (E codes)
Collagen
18. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Albino
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Undetermined
Contracted Rates with MCOs
19. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
itemized statement
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Modifiers
Pubic bone
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.
sprain
essential modifiers
phalanges (phalanx.s)
The Integumentary System
21. 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.
The Integumentary System
False Claims Act (FCA)
Short bones
Electronic Claim
22. major skin pigment
Neoplasm Table
Melanin
Past - family and social history (PFSH)
Musculoskeletal System
23. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
MEDICARE Part C
Hairline
Section 3 Index to External Causes of Injury (E codes)
-99 - Multiple Modifiers
24. Is made up of the shoulder - collar - pelvic and arms and legs
Explanation of Benefits (EOB)
The Universal Claim Form
appendicular skeleton .
Salter-Harris
25. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
The Integumentary System
Malignant
Health practitioner
26. 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
Electronic Claim
axial skeleton
False ribs
Long bones
27. most synarthroses are immovable joints held together by fibrous tissue.
MEDICARE Part A
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
No ROM
Sections
28. 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.
Invalid claim
Fiscal Intermediary
-32 - Mandated Services
Mandible
29. Small collection of clear fluid;blister
There are two types of sweat glands
New patient
Medical Records
Vesicle
30. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Pre-certification
Keratin
Temporal Bone
Employer Identification Number (EIN)
31. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Add-on codes
bullet (a
Neoplasm Table
Review of Systems (ROS)
32. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
Health practitioner
Coordination of Benefits (COB)
-51 - Multiple Procedures
Accept assignment
33. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Deductible
premium
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Long bones
34. requires investigation and needs further clarification.
Rejected claim
Chief complaint (CC)
triangle (a
Radius
35. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Greenstick
Fraud
Primary malignancy
Category I Codes CPT
36. 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.
False ribs
New patient
appendicular skeleton .
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
37. 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.
Complicated
A plus sign (+)
The Universal Claim Form
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
38. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Flat bones
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Established patient
Pre-certification
39. 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)
Greenstick
encounter form
False ribs
40. 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
Point-of-Service plan (POS)
Personal Insurance
Consultation
Vomer
41. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Flat bones
Medically needy
Employer Liability
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
42. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Coinsurance
Full ROM
Group Insurance
Accident
43. 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.
essential modifiers
Colles
Humerus
phalanges (phalanx.s)
44. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
MEDICAID COVERAGE
Greenstick
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
CPT SECTIONS.
45. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
Two triangular symbols (a
Outpatient
Group practice
Medigap (Medicare Supplemental Insurance)
46. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran
Spinal/Vertebral Column
Clearinghouse
Invalid claim
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
47. 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'.
Musculoskeletal System
Gender rule
Pre-authorization
Unlisted Procedures Procedures
48. '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
TRICARE
Full ROM
eponychium
Employee Liability
49. 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
Albino
The St. Anthony Relative Value for Physicians (RVP)
Consultation
Nodule
50. make up part of the roof of the mouth
Location Methods
Ischium
Advance Beneficiary Notice
Palatine bones