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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. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
The St. Anthony Relative Value for Physicians (RVP)
ligaments
-32 - Mandated Services
Paper Claim
2. Is when two insurance companies work together to coordinate payment of the benefits.
Benign (hypertension)
Coordination of Benefits (COB)
State License Number
Contracted Rates with MCOs
3. The physician must obtain this number in order to practice within a state.
State License Number
ulna
Group Insurance
HCPCS Level II codes (National Codes)
4. Further classified as to primary - secondary - or carcinoma in situ.
Malignant
Radius
Unspecified nature
Preferred Provider Organization (PPO)
5. - 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.
Macule
Unauthorized benefit
False ribs
Sphenoid Bones
6. are small with irregular shapes. They are found in the wrist and ankle.
Undetermined
Melanin
Electronic Claim
Short bones
7. Indicates add-on codes
Pre-paid Health Plan
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
A plus sign (+)
encounter form
8. Is made up of the shoulder - collar - pelvic and arms and legs
Benign
Established patient
Non-covered benefit
appendicular skeleton .
9. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Temporal Bone
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Lacrimal bones
Accept assignment
10. paired bones at the corner of each eye that cradle the tear ducts.
Invalid claim
Contracted Rates with MCOs
Lacrimal bones
Exclusions and Limitations
11. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
Clean claim
Capitated Rates
Tabular List (Volume 1)...
Subcategories
12. Is the lateral lower arm bone (in line with the thumb).
Radius
Ischium
-51 - Multiple Procedures
Point-of-Service plan (POS)
13. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
Tabular List (Volume 1)...
Albino
Gender rule
Medigap (Medicare Supplemental Insurance)
14. Represent changes in the text or definition between the triangles.
Commercial Carriers
Invalid claim
Collagen
Two triangular symbols (a
15. 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.
Retention of Medical Records
False ribs
Participating physician
Palatine bones
16. Forms the sides of the cranium
Parietal Bones
Flat bones
encounter form
Limited ROM
17. Mild or controlled hypertension and no damage to the vascular system or organs.
Benign (hypertension)
Category I Codes CPT
Non-covered benefit
Suicide Attempt
18. Contains complete - necessary information - but is incorrect or illogical in some way.
False ribs
upper appendicular skeleton
Group Insurance
Invalid claim
19. 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 -
co-payment
Indemnity Insurance
sprain
Hypertension Table
20. Groove or crack like sore
State License Number
Fissure
Alopecia
lunula
21. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
Social Security Number
Carcinoma (Ca) in situ
The St. Anthony Relative Value for Physicians (RVP)
Multigravida
22. 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....
Fiscal Intermediary
Impacted
Established patient
The Universal Claim Form
23. Number assigned by the insurance company to a physician who renders services to patients.
-99 - Multiple Modifiers
Sebaceous glands
Provider Identification Number (PIN)
Point-of-Service plan (POS)
24. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Spinal/Vertebral Column
Ulcermembranes
Retention of Medical Records
Liability insurance
25. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
MEDICARE Part A
Coordination of Benefits (COB)
Outpatient
Malignant
26. Numbers 1-7 - attach directly to the sternum in the front of the body.
appendicular skeleton .
Category III Codes CPT
true ribs
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
27. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Malignant
Coinsurance
Accept assignment
Primary malignancy
28. Noninvasive - non-spreading - nonmalignant
TRICARE
Reasons for Documentation
Benign
Outpatient
29. 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
Malignant
Categories
Tabular List (Volume 1)...
30. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Liability insurance
Pre-certification
Workers Compensation
Sebaceous glands
31. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Multigravida
Civil Monetary Penalties Law (CMPL)
Advance Beneficiary Notice
Medical necessity
32. 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
Ischium
Sebaceous glands
Unlisted Procedures Procedures
Evaluation and Management Review
33. The fractured area of bone collapses on itself.
Compression fracture
MEDICARE Part D
Performing Provider Identification Number (PPIN)
Group Provider Number
34. The cuticle at the lower part of the nail and this is sometimes referred to as the
itemized statement
Ethmoid Bone
Category II Codes CPT
eponychium
35. 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
Clearinghouse
stand-alone codes
Paper Claim
Established Patient
36. 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 -
essential modifiers
Frontal Bone
nonessential modifiers
Palatine bones
37. major skin pigment
Melanin
Benign
Vesicle
Palatine bones
38. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
ligaments
premium
Humerus
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
39. forms the roof of the nasal cavity.
Humerus
Ethmoid Bone
Fee-for-Service
Keratin
40. Benign growth extending from the surface of the mucous membrane
MEDICARE Part C
Occipital Bone
Impetigo
Polyp
41. The fractured area of bone collapses on itself.
Compression fracture
Sesamoid bones
Coinsurance
New patient
42. Law passed by the federal government to prosecute cases of Medicaid fraud.
Location Methods
Civil Monetary Penalties Law (CMPL)
Pathologic
-26 - Professional Component
43. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
Clean claim
Rib Cage
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Impetigo
44. 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.
Capitated Rates
Palatine bones
Sebaceous glands
Section 3 Index to External Causes of Injury (E codes)
45. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
Fissure
Health Maintenance Organization (HMO)
Palatine bones
46. 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.
Vomer
Add-on codes
Salter-Harris
-26 - Professional Component
47. 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.
encounter form
Pathologic
Pre-determination
Accept assignment
48. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Health Insurance Portability and Accountability Act (HIPAA)
Musculoskeletal System
Coordination of Benefits (COB)
Reasons for Documentation
49. 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
Health Maintenance Organization (HMO)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Outpatient
Occipital Bone
50. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Uncertain behavior
Mutually Exclusive Edits
Fraud
Sub classification