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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. is a traumatic injury to a joint involving the soft tissue.
Spinal/Vertebral Column
Coordination of Benefits (COB)
eponychium
sprain
2. the bone is crushed and or shattered.
Comminuted fracture
eponychium
No ROM
Dirty claim
3. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Inpatient
The Good Samaritan Act
Category I Codes CPT
-51 - Multiple Procedures
4. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:
Invalid claim
Remittance Advice
Benign
Hypertension Table
5. male of household is primary payer
Categorically needy -MEDICAID
History of present illness (HPI)
Complicated
Gender rule
6. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Add-on codes
Health Maintenance Organization (HMO)
Group practice
Pre-certification
7. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin
Established Patient
Benign (hypertension)
-51 - Multiple Procedures
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
8. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Category III Codes CPT
Sebaceous glands
Vesicle
Abuse
9. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Malignant
Pathologic
Workers Compensation
Malignant
10. 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.
Multigravida
Unauthorized benefit
Group practice
Pre-determination
11. The moon like white area at the base of the nail.
sebaceous(oil) glands and the suddoriferous (sweat) glands
lunula
MEDICARE Part B
circle with a line through it)
12. 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
Reasons for Documentation
Nodule
Blue Cross/Blue Shield Plans
Paper Claim
13. This is not specified as benign or malignant in the diagnosis or medical record.
Chapters
The Good Samaritan Act
Musculoskeletal System
Unspecified (hypertension)
14. Typically not used on the claim form unless the provider does not have an EIN.
Social Security Number
Pre-paid Health Plan
-90 - Reference (Outside) Laboratory
Rib Cage
15. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Pelvis
Musculoskeletal System
Fraud
Subcategories
16. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Accident
Coding
Health practitioner
17. 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
Assault
Health Care Financing Administration Common Procedure Coding System
Invalid claim
Multigravida
18. Most billing-related cases are based on HIPAA and False Claims Act.
There are two types of sweat glands
Medical Records
Compliance Regulations
False Claims Act (FCA)
19. 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
Compression fracture
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Relative Value Payment Schedules Method
Compliance Regulations
20. 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.
History
Chief complaint
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
sprain
21. 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....
Employee Liability
Hypertension Table
Established patient
Liability insurance
22. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Medical Records
Mutually Exclusive Edits
Mandible
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
23. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Polyp
Pre-paid Health Plan
Pre-certification
New patient
24. Typically not used on the claim form unless the provider does not have an EIN.
Employee Liability
Social Security Number
Pre-certification
Outpatient
25. 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.
Full ROM
National Correct Coding Initiative (NCCI)
-90 - Reference (Outside) Laboratory
Carpals
26. 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.
eponychium
Workers Compensation
Retention of Medical Records
Contracted Rates with MCOs
27. Is the upper arm bone.
Performing Provider Identification Number (PPIN)
Complicated
Participating physician
Humerus
28. Small collection of clear fluid;blister
MEDICARE Part A
Health Insurance Portability and Accountability Act (HIPAA)
Vesicle
essential modifiers
29. Represents a new procedure or service code added since the previous edition of the manual.
The Current Procedural Terminology (CPT)
bullet (a
Medicare
HCPCS Level II codes (National Codes)
30. 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
Maxilla
Employer Identification Number (EIN)
National Correct Coding Initiative (NCCI)
31. 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
Indemnity Insurance
Comminuted fracture
CPT SECTIONS.
Primary malignancy
32. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Consultation
Unspecified (hypertension)
A plus sign (+)
Malignant
33. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Hairline
Medicare Claim Status
Gender rule
Fiscal Intermediary
34. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Preferred Provider Organization (PPO)
Retention of Medical Records
There are two types of sweat glands
35. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
Musculoskeletal System
Rib Cage
Clean claim
MEDICARE Part C
36. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
Parietal Bones
Clearinghouse
MEDICARE Part D
Modifiers
37. Law passed by the federal government to prosecute cases of Medicaid fraud.
Consultation
Coinsurance
Civil Monetary Penalties Law (CMPL)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
38. requires investigation and needs further clarification.
triangle (a
Rejected claim
-99 - Multiple Modifiers
Carcinoma (Ca) in situ
39. 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
MEDICARE Part C
Coding
Electronic Claim
The Current Procedural Terminology (CPT)
40. anterior to the temporal bones.
Inpatient
Inferior nasal conchae
Sphenoid Bones
Fee Schedule
41. 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'.
Workers Compensation
bullet (a
Mutually Exclusive Edits
Pre-authorization
42. male of household is primary payer
The Universal Claim Form
Gender rule
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Medigap (Medicare Supplemental Insurance)
43. Pre-determined set of benefits covered under one set annual fee.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Pre-paid Health Plan
-26 - Professional Component
Occipital Bone
44. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.
Sebaceous glands
Sphenoid Bones
Personal Insurance
triangle (a
45. 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.
essential modifiers
Albino
Civil Monetary Penalties Law (CMPL)
Section 3 Index to External Causes of Injury (E codes)
46. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Pre-authorization
Physician
Medical Records
triangle (a
47. 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 -
State License Number
Indemnity Insurance
Pathologic
Ulcermembranes
48. Numbers 1-7 - attach directly to the sternum in the front of the body.
true ribs
-50 - Bilateral Procedure
MEDICARE Part B
Salter-Harris
49. 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
Unique Provider Identification Number (UPIN)
Unspecified (hypertension)
Blue Cross/Blue Shield Plans
Category I Codes CPT
50. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Contracted Rates with MCOs
Short bones
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Medical Records