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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. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
Impacted
The Universal Claim Form
axial skeleton
Medicaid
2. Benign growth extending from the surface of the mucous membrane
TRICARE PLANS
Polyp
History
Maxilla
3. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Modifiers
Dirty claim
ligaments
4. 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
Medically needy
Dirty claim
Inpatient
5. 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.
premium
Two triangular symbols (a
Ischium
Clean claim
6. 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
Consultation
Compliance Regulations
Employer Identification Number (EIN)
Fraud
7. 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 -
Keratin
TRICARE PLANS
Indemnity Insurance
MEDICARE Part D
8. The moon like white area at the base of the nail.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
lunula
Frontal Bone
Invalid claim
9. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Collagen
Surgical Package
Chapters
Medicare
10. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Ethmoid Bone
Impetigo
Employer Identification Number (EIN)
Established patient
11. 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
Nonparticipating physician
Collagen
Fee Schedule
Unspecified nature
12. Is when two insurance companies work together to coordinate payment of the benefits.
Malignant
Fiscal Intermediary
Coordination of Benefits (COB)
Consultation
13. Number assigned to the physician by Medicare program.
Unique Provider Identification Number (UPIN)
Peer Review Organization (PRO)
Invalid claim
Limited ROM
14. 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
Section 3 Index to External Causes of Injury (E codes)
The Current Procedural Terminology (CPT)
Zygoma
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
15. 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
State License Number
itemized statement
encounter form
16. Is an electronic or paper-based report of payment sent by the payer to the provider.
Review of Systems (ROS)
Remittance Advice
Alphabetic Index (Volume 2)
Health practitioner
17. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Lacrimal bones
sebaceous(oil) glands and the suddoriferous (sweat) glands
upper appendicular skeleton
18. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
Employer Liability
itemized statement
Add-on codes
Impetigo
19. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
-51 - Multiple Procedures
Fraud
Established Patient
20. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
Medicaid
MEDICARE Part B
HCPCS Level I codes
Unique Provider Identification Number (UPIN)
21. 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
Collagen
Compression fracture
Pathologic
22. 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.
bullet (a
triangle (a
MEDICAID COVERAGE
Macule
23. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.
Long bones
Group Provider Number
Dirty claim
MEDICARE Part D
24. most synarthroses are immovable joints held together by fibrous tissue.
Birthday rule
Sections
Keratin
No ROM
25. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Location Methods
Surgical Package
Qualified diagnosis
Medigap (Medicare Supplemental Insurance)
26. 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
Past - family and social history (PFSH)
Point-of-Service plan (POS)
nonessential modifiers
Suicide Attempt
27. 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
Sesamoid bones
Section 3 Index to External Causes of Injury (E codes)
Medical necessity
28. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Tabular List (Volume 1)...
Modifiers
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Chief complaint
29. The bone is broken and pierces an internal organ
Clean claim
Gender rule
Complicated
ligaments
30. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Sebaceous glands
Coinsurance
A plus sign (+)
Hairline
31. 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
Eligibility
Undetermined
circle with a line through it)
Spinal/Vertebral Column
32. 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
ligaments
MEDICARE Part C
Accident
Group Insurance
33. 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
The St. Anthony Relative Value for Physicians (RVP)
Medically needy
There are three layers to the skin
-51 - Multiple Procedures
34.
Accept assignment
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Humerus
triangle (a
35. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Sebaceous glands
History of present illness (HPI)
appendicular skeleton .
Provider Identification Number (PIN)
36. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Medical Records
Palatine bones
Physician
Mutually Exclusive Edits
37. 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.
appendicular skeleton .
Pre-authorization
Spinal/Vertebral Column
Modifiers
38. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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39. open sore on the skin or mucous
Ulcermembranes
History
encounter form
Spinal/Vertebral Column
40. Are composed of three-digit codes representing a single disease or condition.
TRICARE
-50 - Bilateral Procedure
-90 - Reference (Outside) Laboratory
Categories
41. Contains complete - necessary information - but is incorrect or illogical in some way.
encounter form
Accept assignment
Musculoskeletal System
Invalid claim
42. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Group practice
Sebaceous glands
Short bones
Location Methods
43. male of household is primary payer
Gender rule
False Claims Act (FCA)
Unspecified (hypertension)
Impacted
44. A pregnant woman who has had at least one previous pregnancy.
premium
Multigravida
Short bones
Indemnity Insurance
45. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Participating physician
sprain
Limited ROM
Coinsurance
46. 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
History
HCPCS Level I codes
Spinal/Vertebral Column
Musculoskeletal System
47. Lower portion of the pelvic bone
HCPCS Level I codes
Ischium
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Secondary malignancy
48. 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
Pre-paid Health Plan
Accept assignment
Electronic Claim
essential modifiers
49. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Health Insurance Portability and Accountability Act (HIPAA)
Established patient
50. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
Pelvis
Greenstick
The Integumentary System
New Patient
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