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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. Any fracture occurring spontaneously as a result of disease.
Gangrene
Occipital Bone
Pathologic
encounter form
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
Fee Schedule
Alphabetic Index (Volume 2)
Category III Codes CPT
Pubic bone
3. Any fracture occurring spontaneously as a result of disease.
Macule
Physician
Pathologic
Advance Beneficiary Notice
4. 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
Collagen
Relative Value Payment Schedules Method
Explanation of Benefits (EOB)
Health practitioner
5. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Unlisted Procedures Procedures
Maxilla
Pre-certification
Fissure
6. 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.
Qualified diagnosis
Categorically needy -MEDICAID
-99 - Multiple Modifiers
Add-on codes
7. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
upper appendicular skeleton
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Advance Beneficiary Notice
Fraud
8. The physician must obtain this number in order to practice within a state.
Reasons for Documentation
premium
State License Number
eponychium
9. The reason the patient came to see the physician.
sprain
eponychium
Add-on codes
Chief complaint (CC)
10. Indicates add-on codes
Pubic bone
Long bones
A plus sign (+)
Coinsurance
11. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Qualified diagnosis
Alphabetic Index (Volume 2)
triangle (a
Group practice
12. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Macule
Zygoma
A plus sign (+)
Keratin
13. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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14. 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
Melanin
Health Care Financing Administration Common Procedure Coding System
Pre-certification
15. Is the lower medial arm bone.
MEDICARE Part D
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
ulna
sebaceous(oil) glands and the suddoriferous (sweat) glands
16. anterior to the temporal bones.
Fee-for-Service
Complicated
Parietal Bones
Sphenoid Bones
17. uncertain whether benign or malignant; borderline malignancy
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Electronic Claim
Uncertain behavior
co-payment
18. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
There are two types of sweat glands
eponychium
The Universal Claim Form
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
19. Is an electronic or paper-based report of payment sent by the payer to the provider.
Carpals
MEDICARE Part B
Preferred Provider Organization (PPO)
Remittance Advice
20. Absence of hair from areas where it normally grows
Multigravida
Sub classification
Nodule
Alopecia
21. Number assigned to the physician by Medicare program.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
The Universal Claim Form
Unique Provider Identification Number (UPIN)
sprain
22. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
Group Insurance
New Patient
Reasons for Documentation
Pre-certification
23. Law passed by the federal government to prosecute cases of Medicaid fraud.
nonessential modifiers
Civil Monetary Penalties Law (CMPL)
Review of Systems (ROS)
Polyp
24. .. lower jaw bone.
Mandible
Long bones
-90 - Reference (Outside) Laboratory
HCPCS Level I codes
25. 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
Point-of-Service plan (POS)
-51 - Multiple Procedures
Alopecia
Malignant
26. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Suicide Attempt
Secondary malignancy
Secondary malignancy
premium
27. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
Keratin
The Current Procedural Terminology (CPT)
Comminuted fracture
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
28. 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....
Established patient
sprain
A plus sign (+)
Lipocyte
29. Are composed of three-digit codes representing a single disease or condition.
Paper Claim
Categories
National Correct Coding Initiative (NCCI)
Collagen
30. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Alopecia
Paper Claim
Indemnity Insurance
Short bones
31. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Section 3 Index to External Causes of Injury (E codes)
Spinal/Vertebral Column
Health Care Financing Administration Common Procedure Coding System
Category II Codes CPT
32. 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.
Contracted Rates with MCOs
New patient
Primary malignancy
Medically needy
33. Structural protein found in the skin and connective tissue
Relative Value Payment Schedules Method
Complicated
Collagen
Albino
34. 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.
Category I Codes CPT
Pathologic
Non-covered benefit
Rejected claim
35. 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.
New patient
Pre-authorization
A plus sign (+)
Medicaid
36. 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:
Liability insurance
Medical necessity
Hypertension Table
Medical necessity
37. uncertain whether benign or malignant; borderline malignancy
Lacrimal bones
Uncertain behavior
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
State License Number
38. make up part of the roof of the mouth
circle with a line through it)
Blue Cross/Blue Shield Plans
Palatine bones
-90 - Reference (Outside) Laboratory
39. Are conditions - situations - and services not covered by the insurance carrier.
Blue Cross/Blue Shield Plans
Pre-determination
Exclusions and Limitations
Categorically needy -MEDICAID
40. Groove or crack like sore
nonessential modifiers
Group Provider Number
Gender rule
Fissure
41. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Category II Codes CPT
Undetermined
Mandible
Blue Cross/Blue Shield Plans
42. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
-26 - Professional Component
Outpatient
Secondary malignancy
Unlisted Procedures Procedures
43. 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
Physician
Social Security Number
CPT SECTIONS.
MEDICAID COVERAGE
44. Benign growth extending from the surface of the mucous membrane
Short bones
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Polyp
co-payment
45. Produce secretions that allow the body to be moisturized or cooled.
Relative Value Payment Schedules Method
Gender rule
Hypertension Table
sebaceous(oil) glands and the suddoriferous (sweat) glands
46. 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
Accident
Commercial Carriers
Primary malignancy
Malignant
47. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Greenstick
Impetigo
State License Number
Humerus
48. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Ethmoid Bone
-50 - Bilateral Procedure
Frontal Bone
Musculoskeletal System
49. 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.
Temporal Bone
Inpatient
Invalid claim
-50 - Bilateral Procedure
50. Represents a new procedure or service code added since the previous edition of the manual.
Humerus
bullet (a
-50 - Bilateral Procedure
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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