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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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study here
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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. make up part of the roof of the mouth
essential modifiers
Pathologic
Palatine bones
Benign
2. Deficient in pigment (melanin)
Undetermined
Albino
Medigap (Medicare Supplemental Insurance)
Occipital Bone
3. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Sections
Provider Identification Number (PIN)
Macule
4. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -
Participating physician
Group Provider Number
essential modifiers
Nonparticipating physician
5. 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.
Preferred Provider plan
Accident
Ulcermembranes
Polyp
6. This is not specified as benign or malignant in the diagnosis or medical record.
Coordination of Benefits (COB)
Performing Provider Identification Number (PPIN)
Unspecified (hypertension)
Coding
7. The physician must obtain this number in order to practice within a state.
State License Number
Indemnity Insurance
Accident
-32 - Mandated Services
8. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Provider Identification Number (PIN)
Health Insurance Portability and Accountability Act (HIPAA)
The Current Procedural Terminology (CPT)
phalanges (phalanx.s)
9. 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
Medicare
MEDICAID COVERAGE
Impacted
Assault
10. is a traumatic injury to a joint involving the soft tissue.
Explanation of Benefits (EOB)
sprain
Benign (hypertension)
Health Maintenance Organization (HMO)
11. The bone is broken and pierces an internal organ
Advance Beneficiary Notice
Participating physician
Complicated
Colles
12. 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
Medically needy
Capitated Rates
Electronic Claim
MEDICARE Part D
13. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Mutually Exclusive Edits
Evaluation and Management Review
Reasons for Documentation
Tabular List (Volume 1)...
14. 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
Invalid claim
Malignant
Fee-for-Service
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
15. 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
Accident
axial skeleton
Location Methods
Peer Review Organization (PRO)
16. anterior to the temporal bones.
phalanges (phalanx.s)
MEDICAID COVERAGE
Carcinoma (Ca) in situ
Sphenoid Bones
17. 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.
Section 3 Index to External Causes of Injury (E codes)
Contracted Rates with MCOs
Benign (hypertension)
HCPCS Level I codes
18. The physician must obtain this number in order to practice within a state.
Disability insurance
Rib Cage
State License Number
The St. Anthony Relative Value for Physicians (RVP)
19. 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
Sebaceous glands
Point-of-Service plan (POS)
Clean claim
Explanation of Benefits (EOB)
20. paired bones at the corner of each eye that cradle the tear ducts.
nonessential modifiers
-50 - Bilateral Procedure
Established Patient
Lacrimal bones
21. are small with irregular shapes. They are found in the wrist and ankle.
No ROM
nonessential modifiers
Short bones
Accept assignment
22. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Primary malignancy
Reasons for Documentation
Health Care Financing Administration Common Procedure Coding System
Alphabetic Index (Volume 2)
23. 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.
Albino
Coinsurance
-32 - Mandated Services
Review of Systems (ROS)
24. 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).
Sections
Chapters
Accept assignment
eponychium
25. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Deductible
Nodule
true ribs
Section 3 Index to External Causes of Injury (E codes)
26. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Sections
Section 3 Index to External Causes of Injury (E codes)
TRICARE PLANS
-99 - Multiple Modifiers
27. paired bones at the corner of each eye that cradle the tear ducts.
Reasons for Documentation
Clean claim
Unlisted Procedures Procedures
Lacrimal bones
28. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Category III Codes CPT
Colles
triangle (a
ligaments
29. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Surgical Package
Section 3 Index to External Causes of Injury (E codes)
Unauthorized benefit
30. make up part of the roof of the mouth
Palatine bones
co-payment
Suicide Attempt
Evaluation and Management Review
31. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
Pubic bone
Provider Identification Number (PIN)
Unspecified (hypertension)
Preferred Provider Organization (PPO)
32. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Pubic bone
Sub classification
Capitated Rates
False ribs
33. Number assigned to the physician by Medicare program.
Rejected claim
Unspecified nature
Chief complaint (CC)
Unique Provider Identification Number (UPIN)
34. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
Subcategories
Pre-determination
MEDICARE Part A
The Universal Claim Form
35. 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
Hairline
CPT SECTIONS.
The Universal Claim Form
sprain
36. 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
sebaceous(oil) glands and the suddoriferous (sweat) glands
MEDICARE Part C
Radius
Workers Compensation
37. 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.
Unauthorized benefit
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Carpals
Albino
38. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Reasons for Documentation
Modifiers
Add-on codes
Peer Review Organization (PRO)
39. The poisoning was self-inflicted.
Suicide Attempt
Chapters
Section 3 Index to External Causes of Injury (E codes)
-51 - Multiple Procedures
40. This is the inventory of the constitutional symptoms regarding the various body systems.
Unspecified nature
-90 - Reference (Outside) Laboratory
Medical necessity
Review of Systems (ROS)
41. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
Frontal Bone
Comminuted fracture
encounter form
Employer Liability
42. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
Vesicle
Radius
Lacrimal bones
43. The cuticle at the lower part of the nail and this is sometimes referred to as the
Medicare
eponychium
Liability insurance
-26 - Professional Component
44. 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
Sections
Unspecified nature
Relative Value Payment Schedules Method
Group Insurance
45. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
-90 - Reference (Outside) Laboratory
MEDICAID COVERAGE
Category I Codes CPT
Fiscal Intermediary
46. Cheekbone
Malignant
stand-alone codes
Zygoma
Colles
47. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Invalid claim
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Pre-certification
Carpals
48. Represent changes in the text or definition between the triangles.
Two triangular symbols (a
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
-51 - Multiple Procedures
Employer Identification Number (EIN)
49. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
The Universal Claim Form
Rib Cage
Point-of-Service plan (POS)
Blue Cross/Blue Shield Plans
50. Is made up of the shoulder - collar - pelvic and arms and legs
Melanin
Frontal Bone
appendicular skeleton .
Fissure