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Test your basic knowledge |
Medical Billing And Coding Vocab
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
Health practitioner
Exclusions and Limitations
The Universal Claim Form
Fraud
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
Group practice
Group Insurance
Physician
Employee Liability
3. 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
-90 - Reference (Outside) Laboratory
Accident
Preferred Provider Organization (PPO)
Dirty claim
4. 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
Medical Records
Compliance Regulations
Medicare Claim Status
5. requires investigation and needs further clarification.
Established patient
Rejected claim
Non-covered benefit
Qualified diagnosis
6. 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 -
Malignant
Indemnity Insurance
Consultation
Accident
7. 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.
Medical Records
Keratin
Lacrimal bones
Add-on codes
8. Deficient in pigment (melanin)
Civil Monetary Penalties Law (CMPL)
Medical Records
Disability insurance
Albino
9. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.
Group Provider Number
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
encounter form
Coinsurance
10. forms the roof of the nasal cavity.
Categories
Ethmoid Bone
Location Methods
TRICARE
11. 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
axial skeleton
Capitated Rates
Inpatient
Pelvis
12. 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
Fiscal Intermediary
Malignant
Clean claim
13. 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.
Clean claim
The Current Procedural Terminology (CPT)
Preferred Provider plan
Categorically needy -MEDICAID
14. 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
Electronic Claim
Past - family and social history (PFSH)
Unique Provider Identification Number (UPIN)
Clearinghouse
15. Is the qualifying factor or factors that must be met before a patient receives benefits.
Health Maintenance Organization (HMO)
Modifiers
Limited ROM
Eligibility
16. 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.
Category II Codes CPT
Employee Liability
Abuse
Pre-certification
17. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Malignant
Chapters
Preferred Provider Organization (PPO)
Inpatient
18. 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.
Disability insurance
Invalid claim
phalanges (phalanx.s)
Commercial Carriers
19. The poisoning was self-inflicted.
Suicide Attempt
Ischium
Wheal
New patient
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
Category I Codes CPT
Pre-paid Health Plan
Medicaid
MEDICARE Part B
21. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Full ROM
Established Patient
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
The Patient Care Partnership (Patient's Bill of Rights)
22. The reason the patient came to see the physician.
TRICARE PLANS
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Comminuted fracture
Chief complaint (CC)
23. The moon like white area at the base of the nail.
lunula
There are three layers to the skin
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Keratin
24. Produce secretions that allow the body to be moisturized or cooled.
Sesamoid bones
Compliance Regulations
sebaceous(oil) glands and the suddoriferous (sweat) glands
Pre-certification
25. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fiscal Intermediary
History
New Patient
Physician
26. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
Unspecified nature
Long bones
Two triangular symbols (a
Health Care Financing Administration Common Procedure Coding System
27. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Chief complaint (CC)
Short bones
Salter-Harris
Hairline
28. 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.
CPT SECTIONS.
Unspecified (hypertension)
premium
triangle (a
29. The cuticle at the lower part of the nail and this is sometimes referred to as the
Retention of Medical Records
Mutually Exclusive Edits
eponychium
Surgical Package
30. Discolored - flat lesion (freckles - tattoo marks)
No ROM
History
Remittance Advice
Macule
31. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
upper appendicular skeleton
Keratin
Category III Codes CPT
Pre-paid Health Plan
32. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.
Employer Liability
Ischium
Pre-determination
triangle (a
33. The main term in the index may by followed by terms within parenthesis.
-50 - Bilateral Procedure
Pre-authorization
Alphabetic Index (Volume 2)
Hypertension Table
34. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Malignant
Medically needy
There are three layers to the skin
Category III Codes CPT
35. 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
Preferred Provider plan
Pre-determination
New patient
36. represents Exemption from the use of modifier -51
circle with a line through it)
Location Methods
Medical necessity
Ethmoid Bone
37. 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.
Clean claim
Medically needy
Group practice
Zygoma
38. - 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
Category III Codes CPT
Medigap (Medicare Supplemental Insurance)
Secondary malignancy
Vesicle
39. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).
Malignant
Relative Value Payment Schedules Method
essential modifiers
Sections
40. 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
Health Maintenance Organization (HMO)
Sesamoid bones
Nonparticipating physician
Undetermined
41. 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
Lacrimal bones
upper appendicular skeleton
There are three layers to the skin
Sesamoid bones
42. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Preferred Provider plan
premium
Vesicle
triangle (a
43. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Impetigo
False ribs
Accept assignment
Long bones
44. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Frontal Bone
Group Insurance
Disability insurance
45. Describes the services billed and includes a breakdown of how the payment is determined
Tabular List (Volume 1)...
Explanation of Benefits (EOB)
Workers Compensation
triangle (a
46. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Unauthorized benefit
-32 - Mandated Services
Carcinoma (Ca) in situ
47.
upper appendicular skeleton
Unauthorized benefit
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Lacrimal bones
48. 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
Remittance Advice
-26 - Professional Component
-32 - Mandated Services
49. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
Vesicle
MEDICARE Part C
Inpatient
Relative Value Payment Schedules Method
50. 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.
Inpatient
Long bones
axial skeleton
Coordination of Benefits (COB)
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