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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.
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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 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..
Fraud
Exclusions and Limitations
Explanation of Benefits (EOB)
Musculoskeletal System
2. 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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3. 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.'
Impetigo
Medical necessity
essential modifiers
Assault
4. The poisoning was self-inflicted.
Evaluation and Management Review
Preferred Provider Organization (PPO)
Suicide Attempt
A plus sign (+)
5. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Pathologic
Secondary malignancy
Category III Codes CPT
History of present illness (HPI)
6. 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
TRICARE
CPT SECTIONS.
Ethmoid Bone
Evaluation and Management Review
7. 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
Location Methods
Carpals
Rib Cage
upper appendicular skeleton
8. 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)
Pre-paid Health Plan
Pre-certification
Frontal Bone
9. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Malignant
Capitated Rates
eponychium
Health practitioner
10. Mild or controlled hypertension and no damage to the vascular system or organs.
Advance Beneficiary Notice
Carcinoma (Ca) in situ
axial skeleton
Benign (hypertension)
11. 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.
Benign (hypertension)
sprain
Pre-certification
itemized statement
12. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Humerus
Pelvis
Birthday rule
13. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Established Patient
-32 - Mandated Services
Suicide Attempt
Carpals
14. Consists of the skull - rib cage - and spine
axial skeleton
Sebaceous glands
Chapters
Spinal/Vertebral Column
15. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Assault
-50 - Bilateral Procedure
Coinsurance
Hairline
16. 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
HCPCS Level II codes (National Codes)
Benign
Vomer
Health Maintenance Organization (HMO)
17. 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
nonessential modifiers
Consultation
Vomer
Spinal/Vertebral Column
18. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
Radius
Frontal Bone
Zygoma
19. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Pubic bone
Sesamoid bones
Radius
Medicare Claim Status
20. 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
Preferred Provider Organization (PPO)
Exclusions and Limitations
-99 - Multiple Modifiers
-32 - Mandated Services
21. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Vomer
Disability insurance
encounter form
Physician
22. This is not specified as benign or malignant in the diagnosis or medical record.
Categorically needy -MEDICAID
-26 - Professional Component
Categories
Unspecified (hypertension)
23. Is the qualifying factor or factors that must be met before a patient receives benefits.
Eligibility
TRICARE PLANS
Medical Records
History of present illness (HPI)
24. are small with irregular shapes. They are found in the wrist and ankle.
Short bones
Chief complaint
Indemnity Insurance
Participating physician
25. 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.
Pre-authorization
Pelvis
History
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
26. Absence of hair from areas where it normally grows
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Group Provider Number
Alopecia
27. are small with irregular shapes. They are found in the wrist and ankle.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Personal Insurance
Short bones
Pre-determination
28. Groove or crack like sore
CPT SECTIONS.
Retention of Medical Records
Dirty claim
Fissure
29. 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
-51 - Multiple Procedures
Palatine bones
False ribs
Spinal/Vertebral Column
30. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu
Blue Cross/Blue Shield Plans
Indemnity Insurance
Sphenoid Bones
Coordination of Benefits (COB)
31. 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.
Birthday rule
Clean claim
Inpatient
MEDICARE Part C
32. Noninvasive - non-spreading - nonmalignant
Health Care Financing Administration Common Procedure Coding System
Nonparticipating physician
Benign
Zygoma
33. Any fracture occurring spontaneously as a result of disease.
Categorically needy -MEDICAID
Pathologic
Personal Insurance
New Patient
34. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
Relative Value Payment Schedules Method
Unauthorized benefit
Salter-Harris
MEDICAID COVERAGE
35. most synarthroses are immovable joints held together by fibrous tissue.
The Universal Claim Form
Pre-certification
Impetigo
No ROM
36. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Two triangular symbols (a
Physician
No ROM
37. 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.
Add-on codes
Explanation of Benefits (EOB)
Indemnity Insurance
History of present illness (HPI)
38. The physician must obtain this number in order to practice within a state.
Primary malignancy
Established patient
State License Number
-51 - Multiple Procedures
39. The reason the patient came to see the physician.
Salter-Harris
Chief complaint (CC)
Dirty claim
History of present illness (HPI)
40. the bone is broken and the ends are driven into each other.
Pre-certification
Benign
Uncertain behavior
Impacted
41. 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
False Claims Act (FCA)
There are two types of sweat glands
Fissure
42. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Short bones
Gangrene
History of present illness (HPI)
Subcategories
43. 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
Neoplasm Table
Indemnity Insurance
Consultation
Accident
44. 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
There are three layers to the skin
Provider Identification Number (PIN)
A plus sign (+)
HCPCS Level I codes
45. 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
The Patient Care Partnership (Patient's Bill of Rights)
Birthday rule
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
46. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
-99 - Multiple Modifiers
Fee-for-Service
Long bones
Ischium
47. Forms the anterior part of the skull and the forehead
Unique Provider Identification Number (UPIN)
Qualified diagnosis
Frontal Bone
Categorically needy -MEDICAID
48. poisoning was inflicted by another person with intent to kill or injure
Contracted Rates with MCOs
Assault
-32 - Mandated Services
Pre-paid Health Plan
49. A pregnant woman who has had at least one previous pregnancy.
Multigravida
The Current Procedural Terminology (CPT)
Undetermined
Unauthorized benefit
50. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
A plus sign (+)
Temporal Bone
Column 1/Column 2 (previously called Comprehensive/Component) Edits
lunula