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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. 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
Compression fracture
Invalid claim
Full ROM
Fraud
2. 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
Benign (hypertension)
Comminuted fracture
circle with a line through it)
Birthday rule
3. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
Sub classification
Consultation
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Unlisted Procedures Procedures
4. A pregnant woman who has had at least one previous pregnancy.
Multigravida
Suicide Attempt
Pre-certification
MEDICARE Part D
5. The lower anterior part of the bone
Medically needy
Polyp
Location Methods
Pubic bone
6. 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
MEDICARE Part D
-50 - Bilateral Procedure
Unauthorized benefit
Outpatient
7. requires investigation and needs further clarification.
Review of Systems (ROS)
Rejected claim
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Inpatient
8. 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
Coding
Categories
Malignant
9. 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.
Palatine bones
Physician
Category I Codes CPT
Vomer
10. 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'.
Performing Provider Identification Number (PPIN)
Pre-authorization
Compliance Regulations
Mandible
11. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Benign (hypertension)
Medicaid
Rib Cage
MEDICARE Part A
12. 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
Medical necessity
Accident
Mandible
Alopecia
13. 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
Coordination of Benefits (COB)
False Claims Act (FCA)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
14. 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.
Explanation of Benefits (EOB)
nonessential modifiers
Flat bones
Palatine bones
15. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Musculoskeletal System
Humerus
Peer Review Organization (PRO)
MEDICARE Part B
16. The reason the patient came to see the physician.
Inferior nasal conchae
Chief complaint (CC)
Occipital Bone
Indemnity Insurance
17. Number assigned to the physician by Medicare program.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Unique Provider Identification Number (UPIN)
bullet (a
Patient Confidentiality
18. are small with irregular shapes. They are found in the wrist and ankle.
Multigravida
Short bones
phalanges (phalanx.s)
Medigap (Medicare Supplemental Insurance)
19. 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.
Established Patient
There are three layers to the skin
Retention of Medical Records
Performing Provider Identification Number (PPIN)
20. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
Evaluation and Management Review
Coordination of Benefits (COB)
Colles
-32 - Mandated Services
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
The St. Anthony Relative Value for Physicians (RVP)
Deductible
Employer Liability
Keratin
22. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
Nodule
Patient Confidentiality
Add-on codes
History of present illness (HPI)
23. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Greenstick
Benign (hypertension)
Participating physician
Electronic Claim
24. 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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25. The moon like white area at the base of the nail.
Non-covered benefit
-26 - Professional Component
Inferior nasal conchae
lunula
26. Represent changes in the text or definition between the triangles.
Coordination of Benefits (COB)
Employer Identification Number (EIN)
Two triangular symbols (a
Consultation
27. 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
Paper Claim
sebaceous(oil) glands and the suddoriferous (sweat) glands
The St. Anthony Relative Value for Physicians (RVP)
Deductible
28. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Assault
encounter form
lunula
Pre-authorization
29. 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
phalanges (phalanx.s)
Dirty claim
Preferred Provider Organization (PPO)
Health Care Financing Administration Common Procedure Coding System
30. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Preferred Provider Organization (PPO)
Collagen
Surgical Package
Carpals
31. 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.
Employer Liability
Pre-determination
Medicaid
Sphenoid Bones
32. Is one who has no contract with the health insurance plan.
MEDICARE Part C
Medical Records
Nonparticipating physician
History
33. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Eligibility
Flat bones
Provider Identification Number (PIN)
34. 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
Relative Value Payment Schedules Method
upper appendicular skeleton
There are three layers to the skin
Secondary malignancy
35. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Malignant
Gangrene
Accident
MEDICARE Part A
36. 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
Accept assignment
Fee-for-Service
Accident
MEDICARE Part C
37. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Hairline
Carpals
Unique Provider Identification Number (UPIN)
Advance Beneficiary Notice
38. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Chief complaint
Mutually Exclusive Edits
Preferred Provider plan
Nonparticipating physician
39. Mild or controlled hypertension and no damage to the vascular system or organs.
Benign (hypertension)
Advance Beneficiary Notice
Full ROM
Past - family and social history (PFSH)
40. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Clearinghouse
Coding
A plus sign (+)
Impetigo
41. Consists of the skull - rib cage - and spine
Occipital Bone
ligaments
axial skeleton
Reasons for Documentation
42. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Temporal Bone
Pre-paid Health Plan
Fissure
Secondary malignancy
43. anterior to the temporal bones.
Point-of-Service plan (POS)
Pre-paid Health Plan
Medical necessity
Sphenoid Bones
44. Discolored - flat lesion (freckles - tattoo marks)
Rib Cage
Macule
Medicaid
Pre-certification
45. 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
Carpals
Health Maintenance Organization (HMO)
Group Insurance
Invalid claim
46. 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
Surgical Package
Medical necessity
Two triangular symbols (a
-90 - Reference (Outside) Laboratory
47. 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
Group Provider Number
Accident
Civil Monetary Penalties Law (CMPL)
48. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
Sebaceous glands
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
ligaments
axial skeleton
49. '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
Medicaid
Health Care Financing Administration Common Procedure Coding System
The Universal Claim Form
50. forms the roof of the nasal cavity.
Section 3 Index to External Causes of Injury (E codes)
Fee-for-Service
Birthday rule
Ethmoid Bone