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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 defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
Health practitioner
circle with a line through it)
Vomer
Established Patient
2. The physician must obtain this number in order to practice within a state.
State License Number
Fiscal Intermediary
Keratin
Employer Liability
3. 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.
Sebaceous glands
Group practice
Flat bones
Non-covered benefit
4. forms the two lower sides of the cranium.
Palatine bones
Column 1/Column 2 (previously called Comprehensive/Component) Edits
MEDICARE Part A
Temporal Bone
5. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
MEDICARE Part A
Outpatient
Health practitioner
History of present illness (HPI)
6. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Workers Compensation
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Hairline
Category III Codes CPT
7. anterior to the temporal bones.
Electronic Claim
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
TRICARE
Sphenoid Bones
8. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
Relative Value Payment Schedules Method
Ethmoid Bone
Fissure
9. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Location Methods
Zygoma
Participating physician
Rib Cage
10. 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.
circle with a line through it)
Mutually Exclusive Edits
ligaments
Sesamoid bones
11. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.
Fee Schedule
sebaceous(oil) glands and the suddoriferous (sweat) glands
Group Provider Number
Pre-authorization
12. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Wheal
Medically needy
The Universal Claim Form
lunula
13. Further classified as to primary - secondary - or carcinoma in situ.
Established Patient
Accept assignment
Malignant
MEDICARE Part D
14. 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.
Medigap (Medicare Supplemental Insurance)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Clean claim
Fiscal Intermediary
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.
Colles
Pre-determination
Retention of Medical Records
Hairline
16. 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
Location Methods
Melanin
The Current Procedural Terminology (CPT)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
17. are small with irregular shapes. They are found in the wrist and ankle.
Exclusions and Limitations
-26 - Professional Component
Short bones
Point-of-Service plan (POS)
18. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
ligaments
Chief complaint
eponychium
lunula
19. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Humerus
Peer Review Organization (PRO)
The Integumentary System
Wheal
20. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
MEDICARE Part B
Advance Beneficiary Notice
Category II Codes CPT
Sub classification
21. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Tabular List (Volume 1)...
Unauthorized benefit
State License Number
Add-on codes
22. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Health Insurance Portability and Accountability Act (HIPAA)
Pathologic
Unique Provider Identification Number (UPIN)
Radius
23. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Coding
Paper Claim
Medigap (Medicare Supplemental Insurance)
Impetigo
24. The fractured area of bone collapses on itself.
Compression fracture
Mutually Exclusive Edits
sebaceous(oil) glands and the suddoriferous (sweat) glands
Fiscal Intermediary
25. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
co-payment
Non-covered benefit
History of present illness (HPI)
Health Insurance Portability and Accountability Act (HIPAA)
26. 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.
essential modifiers
Short bones
Participating physician
Modifiers
27. Number assigned to the physician by Medicare program.
Group Insurance
Fiscal Intermediary
Long bones
Unique Provider Identification Number (UPIN)
28. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
HCPCS Level II codes (National Codes)
Compression fracture
Unauthorized benefit
Exclusions and Limitations
29. 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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30. Most billing-related cases are based on HIPAA and False Claims Act.
Impacted
Compliance Regulations
Invalid claim
Unspecified (hypertension)
31. The main term in the index may by followed by terms within parenthesis.
MEDICARE Part A
sebaceous(oil) glands and the suddoriferous (sweat) glands
Alphabetic Index (Volume 2)
Occipital Bone
32. Are composed of three-digit codes representing a single disease or condition.
Short bones
Dirty claim
Categories
Palatine bones
33. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Liability insurance
Coinsurance
Social Security Number
Category I Codes CPT
34. represents Exemption from the use of modifier -51
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
sebaceous(oil) glands and the suddoriferous (sweat) glands
circle with a line through it)
Coinsurance
35. is a traumatic injury to a joint involving the soft tissue.
Coding
MEDICARE Part C
-32 - Mandated Services
sprain
36. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Contracted Rates with MCOs
-32 - Mandated Services
triangle (a
37. Lower portion of the pelvic bone
Ischium
Assault
Secondary malignancy
Sesamoid bones
38. is defined as one who has not received any medical services within the last three years.
Category I Codes CPT
Abuse
New Patient
Add-on codes
39. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Vesicle
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Abuse
Frontal Bone
40. 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
Paper Claim
Group Insurance
Health Insurance Portability and Accountability Act (HIPAA)
Workers Compensation
41. .. lower jaw bone.
Benign
Mandible
There are two types of sweat glands
Advance Beneficiary Notice
42. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Temporal Bone
Contracted Rates with MCOs
False ribs
ligaments
43. Upper jaw bone
Rejected claim
There are three layers to the skin
Maxilla
Lacrimal bones
44. This is the inventory of the constitutional symptoms regarding the various body systems.
Maxilla
Macule
Review of Systems (ROS)
Preferred Provider plan
45. 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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46. the bone is crushed and or shattered.
Unspecified nature
-26 - Professional Component
Comminuted fracture
New Patient
47. open sore on the skin or mucous
Employee Liability
Collagen
Musculoskeletal System
Ulcermembranes
48. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
upper appendicular skeleton
Medicaid
False Claims Act (FCA)
Retention of Medical Records
49. 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.
Undetermined
Complicated
Unlisted Procedures Procedures
triangle (a
50. Poisoning cannot be determined whether intentional or accidental.
Undetermined
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
TRICARE PLANS
Employer Identification Number (EIN)