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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. 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
Group Insurance
Fraud
False Claims Act (FCA)
Relative Value Payment Schedules Method
2. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Employee Liability
Pelvis
Melanin
Personal Insurance
3. Is the lower medial arm bone.
Medical necessity
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
ulna
-99 - Multiple Modifiers
4. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Group Provider Number
False Claims Act (FCA)
Impetigo
Capitated Rates
5. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
Neoplasm Table
Non-covered benefit
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Personal Insurance
6. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
co-payment
Location Methods
Coding
-32 - Mandated Services
7. A fracture of the epiphyseal plate in children.
Salter-Harris
Mutually Exclusive Edits
Vesicle
essential modifiers
8. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:
Hypertension Table
MEDICARE Part B
Malignant
False ribs
9. Discolored - flat lesion (freckles - tattoo marks)
Medical necessity
Category III Codes CPT
Invalid claim
Macule
10. 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
Health Insurance Portability and Accountability Act (HIPAA)
Physician
Workers Compensation
11. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Explanation of Benefits (EOB)
Health Insurance Portability and Accountability Act (HIPAA)
Medical necessity
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
12. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
co-payment
There are three layers to the skin
Workers Compensation
13. The reason the patient came to see the physician.
Birthday rule
Accident
The Good Samaritan Act
Chief complaint (CC)
14. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Pathologic
Polyp
Health Care Financing Administration Common Procedure Coding System
15. 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.
Fissure
Gender rule
Fiscal Intermediary
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
16. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Nodule
appendicular skeleton .
Group practice
No ROM
17. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
Eligibility
phalanges (phalanx.s)
Zygoma
Chief complaint
18. the bone is crushed and or shattered.
Comminuted fracture
Civil Monetary Penalties Law (CMPL)
Explanation of Benefits (EOB)
Non-covered benefit
19. 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..
-99 - Multiple Modifiers
Accident
Musculoskeletal System
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
20. 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
Ulcermembranes
stand-alone codes
The Good Samaritan Act
Mutually Exclusive Edits
21. 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
Multigravida
Employer Liability
Vomer
A plus sign (+)
22. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Zygoma
HCPCS Level I codes
MEDICARE Part A
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
23. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
Category III Codes CPT
Modifiers
MEDICARE Part C
History
24. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
bullet (a
Full ROM
Fee-for-Service
25. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Consultation
Flat bones
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Birthday rule
26. 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.
A plus sign (+)
Gender rule
Collagen
Dirty claim
27. 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
CPT SECTIONS.
There are three layers to the skin
Spinal/Vertebral Column
Unique Provider Identification Number (UPIN)
28. 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
Past - family and social history (PFSH)
Point-of-Service plan (POS)
Flat bones
itemized statement
29. open sore on the skin or mucous
Ulcermembranes
Fiscal Intermediary
A plus sign (+)
Full ROM
30. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Hypertension Table
ulna
Secondary malignancy
Category II Codes CPT
31. 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
appendicular skeleton .
Medicaid
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
32. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Coordination of Benefits (COB)
Commercial Carriers
National Correct Coding Initiative (NCCI)
-90 - Reference (Outside) Laboratory
33. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Medical necessity
Wheal
Indemnity Insurance
False Claims Act (FCA)
34. 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....
Fee-for-Service
Reasons for Documentation
The St. Anthony Relative Value for Physicians (RVP)
Impacted
35. 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
There are three layers to the skin
Surgical Package
essential modifiers
true ribs
36. Is the qualifying factor or factors that must be met before a patient receives benefits.
Deductible
Undetermined
The Universal Claim Form
Eligibility
37. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Vesicle
Contracted Rates with MCOs
Pre-determination
Health Insurance Portability and Accountability Act (HIPAA)
38. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
lunula
Alphabetic Index (Volume 2)
Assault
History of present illness (HPI)
39. Poisoning cannot be determined whether intentional or accidental.
Medicare
Vomer
Undetermined
Fee Schedule
40. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
Fraud
Sub classification
Category I Codes CPT
41. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Established Patient
Two triangular symbols (a
Maxilla
42. 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
Section 3 Index to External Causes of Injury (E codes)
Remittance Advice
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
There are three layers to the skin
43. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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44. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
Modifiers
Inferior nasal conchae
Civil Monetary Penalties Law (CMPL)
45. Is the upper arm bone.
Undetermined
Humerus
Unauthorized benefit
Medical necessity
46. Superior and widest bone
Physician
Unspecified (hypertension)
Pelvis
Vesicle
47. 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
Capitated Rates
-51 - Multiple Procedures
TRICARE PLANS
Alopecia
48. 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.
Assault
Sesamoid bones
Birthday rule
Social Security Number
49. The physician must obtain this number in order to practice within a state.
Short bones
State License Number
Assault
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
50. Mild or controlled hypertension and no damage to the vascular system or organs.
co-payment
Fraud
TRICARE
Benign (hypertension)