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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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 one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Gender rule
Vomer
Participating physician
Medically needy
2. Consists of the skull - rib cage - and spine
The St. Anthony Relative Value for Physicians (RVP)
Paper Claim
axial skeleton
Long bones
3. Represent changes in the text or definition between the triangles.
bullet (a
Greenstick
Ischium
Two triangular symbols (a
4. The cuticle at the lower part of the nail and this is sometimes referred to as the
Hypertension Table
No ROM
eponychium
Alopecia
5. Consists of the skull - rib cage - and spine
Group practice
axial skeleton
Suicide Attempt
phalanges (phalanx.s)
6. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Unspecified nature
Deductible
Impetigo
HCPCS Level I codes
7. requires investigation and needs further clarification.
Rejected claim
Location Methods
Commercial Carriers
MEDICARE Part C
8. Is the upper arm bone.
Coordination of Benefits (COB)
Humerus
Remittance Advice
Category II Codes CPT
9. 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.
triangle (a
Advance Beneficiary Notice
Palatine bones
Medicaid
10. This is the inventory of the constitutional symptoms regarding the various body systems.
Workers Compensation
Relative Value Payment Schedules Method
Review of Systems (ROS)
Compression fracture
11. Is the qualifying factor or factors that must be met before a patient receives benefits.
Provider Identification Number (PIN)
Nodule
Uncertain behavior
Eligibility
12. 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
Categorically needy -MEDICAID
Rib Cage
Frontal Bone
Employer Liability
13. 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
MEDICARE Part D
Colles
Unspecified nature
Medical Records
14. - 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.
ulna
False Claims Act (FCA)
Unauthorized benefit
Electronic Claim
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
Location Methods
Health Insurance Portability and Accountability Act (HIPAA)
Paper Claim
Accident
16. Pre-determined set of benefits covered under one set annual fee.
Personal Insurance
Pre-paid Health Plan
Remittance Advice
Ethmoid Bone
17. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Disability insurance
Categorically needy -MEDICAID
The St. Anthony Relative Value for Physicians (RVP)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
18. Most billing-related cases are based on HIPAA and False Claims Act.
Alphabetic Index (Volume 2)
Coding
Medical Records
Compliance Regulations
19. 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
Carcinoma (Ca) in situ
Group Insurance
Inferior nasal conchae
-26 - Professional Component
20. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
MEDICARE Part C
Rib Cage
Impetigo
Keratin
21. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.
Physician
Polyp
Pathologic
Malignant
22. The reason the patient came to see the physician.
HCPCS Level II codes (National Codes)
Two triangular symbols (a
Lipocyte
Chief complaint (CC)
23. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
TRICARE PLANS
Sub classification
Abuse
Medicare Claim Status
24. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Pelvis
Clearinghouse
Keratin
25. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Inpatient
Personal Insurance
Pelvis
Employer Identification Number (EIN)
26. A fracture of the epiphyseal plate in children.
Uncertain behavior
Salter-Harris
Compression fracture
Greenstick
27. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Pre-determination
Chapters
Tabular List (Volume 1)...
Wheal
28. forms the two lower sides of the cranium.
Category I Codes CPT
Temporal Bone
Polyp
Workers Compensation
29. 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
Medicare
Undetermined
Secondary malignancy
30. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
Neoplasm Table
-99 - Multiple Modifiers
State License Number
Macule
31. 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.
-90 - Reference (Outside) Laboratory
Medical Records
Deductible
HCPCS Level I codes
32. 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
Coinsurance
Colles
Clearinghouse
lunula
33. - 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
circle with a line through it)
State License Number
Fraud
Medigap (Medicare Supplemental Insurance)
34. 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.
triangle (a
Paper Claim
Chapters
Inferior nasal conchae
35. 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.
triangle (a
Inpatient
Salter-Harris
Health practitioner
36. The physician must obtain this number in order to practice within a state.
Employer Identification Number (EIN)
Impetigo
State License Number
triangle (a
37. Mild or controlled hypertension and no damage to the vascular system or organs.
Benign (hypertension)
Performing Provider Identification Number (PPIN)
Evaluation and Management Review
Contracted Rates with MCOs
38. Indicates add-on codes
Abuse
A plus sign (+)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Pre-authorization
39. represents Exemption from the use of modifier -51
Pre-certification
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Mutually Exclusive Edits
circle with a line through it)
40. paired bones at the corner of each eye that cradle the tear ducts.
Modifiers
Performing Provider Identification Number (PPIN)
-90 - Reference (Outside) Laboratory
Lacrimal bones
41. 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
-51 - Multiple Procedures
Rejected claim
Category II Codes CPT
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.
Temporal Bone
-26 - Professional Component
triangle (a
Category III Codes CPT
43. are small with irregular shapes. They are found in the wrist and ankle.
There are two types of sweat glands
Polyp
Greenstick
Short bones
44. The poisoning was self-inflicted.
Liability insurance
Gangrene
Sesamoid bones
Suicide Attempt
45. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
Unspecified (hypertension)
-51 - Multiple Procedures
Hairline
National Correct Coding Initiative (NCCI)
46. 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
TRICARE PLANS
Section 3 Index to External Causes of Injury (E codes)
Spinal/Vertebral Column
National Correct Coding Initiative (NCCI)
47. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Category III Codes CPT
Medically needy
MEDICAID COVERAGE
-90 - Reference (Outside) Laboratory
48. uncertain whether benign or malignant; borderline malignancy
Uncertain behavior
-90 - Reference (Outside) Laboratory
Greenstick
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
49. Are composed of three-digit codes representing a single disease or condition.
Frontal Bone
MEDICARE Part B
Categories
Pubic bone
50. 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
Nonparticipating physician
TRICARE
Commercial Carriers
Physician