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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.
If you are not ready to take this test, you can
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. 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)
Past - family and social history (PFSH)
circle with a line through it)
No ROM
2. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.
Preferred Provider plan
Temporal Bone
Inpatient
Inpatient
3. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
History of present illness (HPI)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Electronic Claim
Colles
4. male of household is primary payer
Lipocyte
Hypertension Table
Medical necessity
Gender rule
5. Is an electronic or paper-based report of payment sent by the payer to the provider.
stand-alone codes
Explanation of Benefits (EOB)
Remittance Advice
Pre-certification
6. 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:
Category III Codes CPT
Malignant
-32 - Mandated Services
Hypertension Table
7. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Rib Cage
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Chief complaint
Coinsurance
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:
Coding
Location Methods
Hypertension Table
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
9. Numbers 1-7 - attach directly to the sternum in the front of the body.
true ribs
premium
Paper Claim
Nodule
10. 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
Relative Value Payment Schedules Method
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Non-covered benefit
Collagen
11. 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
Subcategories
Patient Confidentiality
Pre-certification
Full ROM
12. '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
Fissure
Deductible
Spinal/Vertebral Column
13. 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).
Medigap (Medicare Supplemental Insurance)
Vesicle
Chapters
Abuse
14. requires investigation and needs further clarification.
Alphabetic Index (Volume 2)
Rejected claim
False Claims Act (FCA)
Accident
15. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Chief complaint
Radius
encounter form
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
16. 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
Medically needy
TRICARE PLANS
Full ROM
The Integumentary System
17. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Established patient
There are two types of sweat glands
Inferior nasal conchae
Carcinoma (Ca) in situ
18. Is an electronic or paper-based report of payment sent by the payer to the provider.
Uncertain behavior
Remittance Advice
Coding
Categorically needy -MEDICAID
19. A fracture of the epiphyseal plate in children.
Unique Provider Identification Number (UPIN)
Salter-Harris
Fraud
Rejected claim
20. Produce secretions that allow the body to be moisturized or cooled.
axial skeleton
Health Maintenance Organization (HMO)
sebaceous(oil) glands and the suddoriferous (sweat) glands
No ROM
21. 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
Vesicle
Advance Beneficiary Notice
Pelvis
upper appendicular skeleton
22. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Hairline
Workers Compensation
Unique Provider Identification Number (UPIN)
Health Insurance Portability and Accountability Act (HIPAA)
23. 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
Polyp
The Universal Claim Form
Lacrimal bones
Frontal Bone
24. The physician must obtain this number in order to practice within a state.
The Patient Care Partnership (Patient's Bill of Rights)
phalanges (phalanx.s)
State License Number
Malignant
25. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
Unique Provider Identification Number (UPIN)
The Good Samaritan Act
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
26. 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
TRICARE PLANS
Remittance Advice
Unique Provider Identification Number (UPIN)
Fee-for-Service
27. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
MEDICARE Part D
Advance Beneficiary Notice
Deductible
Vomer
28. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Collagen
Short bones
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Performing Provider Identification Number (PPIN)
29. the bone is crushed and or shattered.
Comminuted fracture
Established patient
Coinsurance
Palatine bones
30. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -
Occipital Bone
essential modifiers
Surgical Package
Commercial Carriers
31. Represent changes in the text or definition between the triangles.
Medically needy
Two triangular symbols (a
Medicare
Hypertension Table
32. Lower portion of the pelvic bone
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Group practice
appendicular skeleton .
Ischium
33. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Neoplasm Table
Keratin
Two triangular symbols (a
Category I Codes CPT
34. poisoning was inflicted by another person with intent to kill or injure
triangle (a
Assault
appendicular skeleton .
Impetigo
35. 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
History
Ischium
The Universal Claim Form
Group Insurance
36. Poisoning cannot be determined whether intentional or accidental.
essential modifiers
Remittance Advice
Full ROM
Undetermined
37. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Retention of Medical Records
-90 - Reference (Outside) Laboratory
New Patient
Long bones
38.
Melanin
Relative Value Payment Schedules Method
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Frontal Bone
39. 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
Accident
Comminuted fracture
upper appendicular skeleton
Liability insurance
40. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Blue Cross/Blue Shield Plans
bullet (a
Secondary malignancy
phalanges (phalanx.s)
41. 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).
Chapters
Vomer
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
MEDICARE Part A
42. 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.
Impacted
Dirty claim
Add-on codes
Coding
43. Is the lateral lower arm bone (in line with the thumb).
Radius
Assault
Add-on codes
Evaluation and Management Review
44. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
CPT SECTIONS.
nonessential modifiers
Full ROM
sebaceous(oil) glands and the suddoriferous (sweat) glands
45. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
Polyp
Salter-Harris
nonessential modifiers
Fraud
46. The bone is broken and pierces an internal organ
Evaluation and Management Review
Neoplasm Table
Complicated
Colles
47. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
true ribs
MEDICARE Part D
Hairline
History of present illness (HPI)
48. 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
MEDICARE Part C
Compression fracture
Review of Systems (ROS)
true ribs
49. 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.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Health Care Financing Administration Common Procedure Coding System
Sections
Commercial Carriers
50. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Commercial Carriers
Spinal/Vertebral Column
Disability insurance
Pre-paid Health Plan