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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 number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Group Provider Number
The Patient Care Partnership (Patient's Bill of Rights)
Category I Codes CPT
2. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Frontal Bone
Carcinoma (Ca) in situ
Compliance Regulations
New Patient
3. 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.
true ribs
Medicare Claim Status
Pathologic
Column 1/Column 2 (previously called Comprehensive/Component) Edits
4. 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..
Preferred Provider plan
Wheal
Musculoskeletal System
Nodule
5. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Add-on codes
Keratin
Peer Review Organization (PRO)
Benign
6. Produce secretions that allow the body to be moisturized or cooled.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Point-of-Service plan (POS)
-50 - Bilateral Procedure
Macule
7. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi
Colles
Health Maintenance Organization (HMO)
Flat bones
Health Care Financing Administration Common Procedure Coding System
8. The reason the patient came to see the physician.
true ribs
triangle (a
Unauthorized benefit
Chief complaint (CC)
9. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Vomer
Colles
Employer Identification Number (EIN)
Unspecified nature
10. requires investigation and needs further clarification.
Category II Codes CPT
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Rejected claim
Clean claim
11. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
There are two types of sweat glands
-26 - Professional Component
HCPCS Level I codes
Category I Codes CPT
12. Make up part of the interior of the nose.
False ribs
Inferior nasal conchae
Medigap (Medicare Supplemental Insurance)
Long bones
13. 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
Civil Monetary Penalties Law (CMPL)
Lacrimal bones
Fraud
Sections
14. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
premium
Spinal/Vertebral Column
There are three layers to the skin
The Current Procedural Terminology (CPT)
15. 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
Consultation
Fee Schedule
Sesamoid bones
triangle (a
16. 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.
axial skeleton
Nodule
Abuse
-32 - Mandated Services
17. The bone is broken and pierces an internal organ
Pre-certification
Employee Liability
State License Number
Complicated
18. Is an electronic or paper-based report of payment sent by the payer to the provider.
Remittance Advice
A plus sign (+)
ligaments
Humerus
19. 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.
Greenstick
Impacted
National Correct Coding Initiative (NCCI)
Modifiers
20. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
MEDICAID COVERAGE
ulna
Pre-authorization
Rejected claim
21. The cuticle at the lower part of the nail and this is sometimes referred to as the
False Claims Act (FCA)
Personal Insurance
eponychium
Civil Monetary Penalties Law (CMPL)
22. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Gender rule
The St. Anthony Relative Value for Physicians (RVP)
Mutually Exclusive Edits
Dirty claim
23. 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)
bullet (a
Undetermined
History
24. 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
Subcategories
Spinal/Vertebral Column
Pelvis
Primary malignancy
25. 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.
Melanin
Evaluation and Management Review
Birthday rule
nonessential modifiers
26. 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
-51 - Multiple Procedures
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Add-on codes
Eligibility
27. 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)...
Unique Provider Identification Number (UPIN)
Spinal/Vertebral Column
Impacted
28. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Commercial Carriers
Medicaid
-90 - Reference (Outside) Laboratory
Flat bones
29. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Albino
Birthday rule
Modifiers
Remittance Advice
30. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Carpals
Categories
Medical Records
Ethmoid Bone
31. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Social Security Number
Unspecified (hypertension)
Fee Schedule
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
32. 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
Medically needy
Evaluation and Management Review
No ROM
Clearinghouse
33. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
The Good Samaritan Act
-99 - Multiple Modifiers
Palatine bones
Patient Confidentiality
34. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Established Patient
Category III Codes CPT
Pre-certification
Modifiers
35. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Nodule
No ROM
phalanges (phalanx.s)
36. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Commercial Carriers
Tabular List (Volume 1)...
The Good Samaritan Act
Complicated
37. 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
Collagen
Outpatient
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Accident
38. the bone is broken and the ends are driven into each other.
Impacted
ulna
Pre-certification
Long bones
39. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
Mandible
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Personal Insurance
40. 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.
Reasons for Documentation
sebaceous(oil) glands and the suddoriferous (sweat) glands
Performing Provider Identification Number (PPIN)
Comminuted fracture
41. 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
Sphenoid Bones
Sphenoid Bones
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Medicare Claim Status
42. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Health practitioner
Chief complaint (CC)
Exclusions and Limitations
Modifiers
43. The cuticle at the lower part of the nail and this is sometimes referred to as the
False ribs
Malignant
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
eponychium
44. Law passed by the federal government to prosecute cases of Medicaid fraud.
Tabular List (Volume 1)...
lunula
Two triangular symbols (a
Civil Monetary Penalties Law (CMPL)
45. forms the roof of the nasal cavity.
Gangrene
Medicare Claim Status
Ethmoid Bone
Health Care Financing Administration Common Procedure Coding System
46. 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.
Benign
Unspecified (hypertension)
MEDICAID COVERAGE
Pre-determination
47. Small collection of clear fluid;blister
Category II Codes CPT
Vesicle
The St. Anthony Relative Value for Physicians (RVP)
Multigravida
48. Consists of the skull - rib cage - and spine
Abuse
axial skeleton
Peer Review Organization (PRO)
Nodule
49. Pre-determined set of benefits covered under one set annual fee.
Indemnity Insurance
Social Security Number
Chapters
Pre-paid Health Plan
50. A fat cell
Workers Compensation
Fee Schedule
Fissure
Lipocyte