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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. The reason the patient came to see the physician.
Salter-Harris
-26 - Professional Component
Chief complaint (CC)
phalanges (phalanx.s)
2. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Accident
Inferior nasal conchae
sprain
3. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
HCPCS Level I codes
Location Methods
Ulcermembranes
Nonparticipating physician
4. 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 -
Indemnity Insurance
Employee Liability
Multigravida
Advance Beneficiary Notice
5. 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
The Current Procedural Terminology (CPT)
Suicide Attempt
essential modifiers
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
6. 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
Relative Value Payment Schedules Method
upper appendicular skeleton
Salter-Harris
Medical necessity
7. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Benign
Tabular List (Volume 1)...
Fee Schedule
Categorically needy -MEDICAID
8. 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.
Mutually Exclusive Edits
Malignant
triangle (a
Employer Liability
9. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Pelvis
Health Insurance Portability and Accountability Act (HIPAA)
Capitated Rates
Medicaid
10. paired bones at the corner of each eye that cradle the tear ducts.
Melanin
New Patient
Tabular List (Volume 1)...
Lacrimal bones
11. 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.
Health Care Financing Administration Common Procedure Coding System
False Claims Act (FCA)
Commercial Carriers
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
12. Typically not used on the claim form unless the provider does not have an EIN.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Social Security Number
Vesicle
Primary malignancy
13. 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
Hypertension Table
The Patient Care Partnership (Patient's Bill of Rights)
Past - family and social history (PFSH)
Undetermined
14. 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.
Health Insurance Portability and Accountability Act (HIPAA)
lunula
Colles
False ribs
15. Pre-determined set of benefits covered under one set annual fee.
Parietal Bones
CPT SECTIONS.
Frontal Bone
Pre-paid Health Plan
16. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
ulna
Relative Value Payment Schedules Method
Clean claim
Ethmoid Bone
17. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Location Methods
Inferior nasal conchae
Deductible
18. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Neoplasm Table
Compression fracture
Lacrimal bones
19. the bone is crushed and or shattered.
Fissure
Comminuted fracture
-26 - Professional Component
Employee Liability
20. 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
Categorically needy -MEDICAID
Indemnity Insurance
Fee Schedule
Surgical Package
21. 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
Flat bones
essential modifiers
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
22. 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 -
Performing Provider Identification Number (PPIN)
essential modifiers
National Correct Coding Initiative (NCCI)
Dirty claim
23. 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
Health Maintenance Organization (HMO)
HCPCS Level I codes
Paper Claim
Lipocyte
24. most synarthroses are immovable joints held together by fibrous tissue.
History of present illness (HPI)
Maxilla
No ROM
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
25. 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
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Parietal Bones
Reasons for Documentation
MEDICAID COVERAGE
26. Benign growth extending from the surface of the mucous membrane
phalanges (phalanx.s)
Polyp
Category III Codes CPT
Unauthorized benefit
27. Further classified as to primary - secondary - or carcinoma in situ.
Malignant
Flat bones
Health Insurance Portability and Accountability Act (HIPAA)
Gangrene
28. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
phalanges (phalanx.s)
Health practitioner
There are two types of sweat glands
False ribs
29. the bone is broken and the ends are driven into each other.
Impacted
Short bones
MEDICARE Part A
Advance Beneficiary Notice
30. 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
Sphenoid Bones
premium
Employee Liability
Clearinghouse
31. 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
The Universal Claim Form
Surgical Package
Evaluation and Management Review
Indemnity Insurance
32. 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..
Musculoskeletal System
Occipital Bone
A plus sign (+)
Unspecified nature
33. 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
Relative Value Payment Schedules Method
Ischium
Evaluation and Management Review
Greenstick
34. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Ethmoid Bone
Group Insurance
Liability insurance
35. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
The Universal Claim Form
Liability insurance
Undetermined
Medicare
36. 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
Categories
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
There are three layers to the skin
Evaluation and Management Review
37. Numbers 1-7 - attach directly to the sternum in the front of the body.
Impacted
Pathologic
true ribs
Unspecified nature
38. 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
Unlisted Procedures Procedures
Fee Schedule
Keratin
39. 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
Coordination of Benefits (COB)
No ROM
Unspecified (hypertension)
Preferred Provider Organization (PPO)
40. the bone is crushed and or shattered.
Liability insurance
Comminuted fracture
Compliance Regulations
upper appendicular skeleton
41. The reason the patient came to see the physician.
Retention of Medical Records
Chief complaint (CC)
Social Security Number
lunula
42. 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
Fissure
Pre-certification
Nonparticipating physician
43. Poisoning cannot be determined whether intentional or accidental.
Undetermined
Sphenoid Bones
Ischium
Social Security Number
44. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Pathologic
The Good Samaritan Act
Inferior nasal conchae
Mutually Exclusive Edits
45. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
stand-alone codes
There are two types of sweat glands
Reasons for Documentation
Chief complaint (CC)
46. 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
Consultation
Electronic Claim
Suicide Attempt
Maxilla
47. Deficient in pigment (melanin)
Temporal Bone
History
Albino
Alphabetic Index (Volume 2)
48. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Employer Liability
Fee-for-Service
lunula
encounter form
49. Superior and widest bone
Health Maintenance Organization (HMO)
Alopecia
Temporal Bone
Pelvis
50. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Categorically needy -MEDICAID
Group practice
Radius
Health practitioner