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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. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Pre-certification
Employee Liability
Primary malignancy
Category III Codes CPT
2. 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
Established Patient
Sebaceous glands
Preferred Provider Organization (PPO)
Pelvis
3. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
New Patient
Macule
Medically needy
Pubic bone
4. Mild or controlled hypertension and no damage to the vascular system or organs.
Benign (hypertension)
Suicide Attempt
Coding
Lipocyte
5. Contains complete - necessary information - but is incorrect or illogical in some way.
Location Methods
Indemnity Insurance
Invalid claim
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
6. 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
Clean claim
Birthday rule
Keratin
Reasons for Documentation
7. The moon like white area at the base of the nail.
Health practitioner
lunula
Provider Identification Number (PIN)
Coding
8. open sore on the skin or mucous
eponychium
Ulcermembranes
Retention of Medical Records
TRICARE
9. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Pre-certification
Limited ROM
Invalid claim
Point-of-Service plan (POS)
10. This is not specified as benign or malignant in the diagnosis or medical record.
Preferred Provider plan
Provider Identification Number (PIN)
Gangrene
Unspecified (hypertension)
11. 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.
Maxilla
Chief complaint (CC)
Nonparticipating physician
Non-covered benefit
12. Is the upper arm bone.
Humerus
Dirty claim
Albino
Musculoskeletal System
13. Forms the anterior part of the skull and the forehead
Frontal Bone
Outpatient
Civil Monetary Penalties Law (CMPL)
Abuse
14. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Colles
Unauthorized benefit
Unspecified nature
Multigravida
15. '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
-90 - Reference (Outside) Laboratory
Preferred Provider plan
Employee Liability
Non-covered benefit
16. 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....
Health practitioner
Melanin
Sub classification
The St. Anthony Relative Value for Physicians (RVP)
17. Represents a new procedure or service code added since the previous edition of the manual.
Provider Identification Number (PIN)
Secondary malignancy
bullet (a
Reasons for Documentation
18. A fat cell
Lacrimal bones
MEDICARE Part D
Lipocyte
lunula
19. is a traumatic injury to a joint involving the soft tissue.
Comminuted fracture
Compliance Regulations
sprain
Unspecified (hypertension)
20. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Malignant
Short bones
The Patient Care Partnership (Patient's Bill of Rights)
21. Is made up of the shoulder - collar - pelvic and arms and legs
History
appendicular skeleton .
Collagen
Qualified diagnosis
22. poisoning was inflicted by another person with intent to kill or injure
There are three layers to the skin
The Current Procedural Terminology (CPT)
Assault
Provider Identification Number (PIN)
23. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Capitated Rates
Indemnity Insurance
Sub classification
Collagen
24. the bone is broken and the ends are driven into each other.
Impacted
co-payment
MEDICARE Part B
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
25. 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
Established Patient
Fee Schedule
TRICARE PLANS
Macule
26. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Collagen
Deductible
Chief complaint
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
27. 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.
False ribs
Sebaceous glands
Section 3 Index to External Causes of Injury (E codes)
triangle (a
28. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Exclusions and Limitations
Colles
Chief complaint
-26 - Professional Component
29. Noninvasive - non-spreading - nonmalignant
Benign
New patient
There are two types of sweat glands
ulna
30. The main term in the index may by followed by terms within parenthesis.
Health Maintenance Organization (HMO)
Alphabetic Index (Volume 2)
Clearinghouse
nonessential modifiers
31. Most billing-related cases are based on HIPAA and False Claims Act.
Hypertension Table
Fraud
Compliance Regulations
Column 1/Column 2 (previously called Comprehensive/Component) Edits
32. 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.
Personal Insurance
Established Patient
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Categorically needy -MEDICAID
33. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Carcinoma (Ca) in situ
Radius
Zygoma
Wheal
34. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Qualified diagnosis
Sesamoid bones
lunula
There are two types of sweat glands
35. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Chief complaint (CC)
There are three layers to the skin
Categorically needy -MEDICAID
Established patient
36. Is the lower medial arm bone.
ulna
MEDICARE Part C
-50 - Bilateral Procedure
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
37. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
Section 3 Index to External Causes of Injury (E codes)
Carpals
Category III Codes CPT
38. uncertain whether benign or malignant; borderline malignancy
Carcinoma (Ca) in situ
Electronic Claim
Uncertain behavior
Pubic bone
39. 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.
Assault
Unique Provider Identification Number (UPIN)
Benign
Group practice
40. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Fee Schedule
phalanges (phalanx.s)
Long bones
Alopecia
41. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Benign
The Good Samaritan Act
42. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
The Integumentary System
circle with a line through it)
Participating physician
Electronic Claim
43. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Qualified diagnosis
Deductible
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
44. The reason the patient came to see the physician.
Secondary malignancy
Chief complaint (CC)
Melanin
Vesicle
45. - 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.
Unauthorized benefit
Vomer
Gender rule
Pubic bone
46. Indicates add-on codes
Medical necessity
A plus sign (+)
Two triangular symbols (a
Point-of-Service plan (POS)
47. 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
axial skeleton
Sesamoid bones
axial skeleton
MEDICARE Part C
48. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
Occipital Bone
Provider Identification Number (PIN)
Group Provider Number
Abuse
49. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
Limited ROM
Suicide Attempt
essential modifiers
50. - 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
Compression fracture
Medicaid
Medigap (Medicare Supplemental Insurance)
Indemnity Insurance