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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. 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.
Category II Codes CPT
Modifiers
TRICARE
Primary malignancy
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
Greenstick
Multigravida
Category III Codes CPT
3. .. lower jaw bone.
Mandible
New Patient
Occipital Bone
The Good Samaritan Act
4. 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
Palatine bones
Health Maintenance Organization (HMO)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
5. Is a working diagnosis which is not yet established.
Qualified diagnosis
TRICARE
Rib Cage
Unique Provider Identification Number (UPIN)
6. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fissure
Fiscal Intermediary
Ischium
New patient
7. 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
Health practitioner
TRICARE
Mutually Exclusive Edits
Electronic Claim
8. Small collection of clear fluid;blister
Ischium
Long bones
Vesicle
Chapters
9. 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).
Pathologic
Sections
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Workers Compensation
10. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Chief complaint
-50 - Bilateral Procedure
Short bones
Medicare Claim Status
11. 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
Group practice
Hypertension Table
Health Maintenance Organization (HMO)
sebaceous(oil) glands and the suddoriferous (sweat) glands
12. 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.
triangle (a
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Alphabetic Index (Volume 2)
Occipital Bone
13. 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
Consultation
Subcategories
Category III Codes CPT
Employer Liability
14. .. lower jaw bone.
MEDICARE Part A
Mandible
Peer Review Organization (PRO)
Invalid claim
15. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
co-payment
Point-of-Service plan (POS)
Coding
Lipocyte
16. The moon like white area at the base of the nail.
History
The Current Procedural Terminology (CPT)
lunula
Column 1/Column 2 (previously called Comprehensive/Component) Edits
17. Is the lateral lower arm bone (in line with the thumb).
Compression fracture
Radius
Medicare Claim Status
Workers Compensation
18. 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.
Secondary malignancy
Performing Provider Identification Number (PPIN)
-50 - Bilateral Procedure
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
19. 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....
Health Insurance Portability and Accountability Act (HIPAA)
Established patient
Two triangular symbols (a
Ulcermembranes
20. Is the qualifying factor or factors that must be met before a patient receives benefits.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Category II Codes CPT
Eligibility
Rejected claim
21. Is one who has no contract with the health insurance plan.
Full ROM
Nonparticipating physician
Modifiers
Surgical Package
22. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Established patient
Fiscal Intermediary
Occipital Bone
-90 - Reference (Outside) Laboratory
23. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
phalanges (phalanx.s)
Capitated Rates
Occipital Bone
Coding
24. 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
MEDICARE Part B
Categorically needy -MEDICAID
Qualified diagnosis
Ethmoid Bone
25. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Lacrimal bones
Wheal
Medical necessity
Pathologic
26. Lower portion of the pelvic bone
Ischium
Health Insurance Portability and Accountability Act (HIPAA)
Frontal Bone
sebaceous(oil) glands and the suddoriferous (sweat) glands
27. Are conditions - situations - and services not covered by the insurance carrier.
Chief complaint (CC)
Lipocyte
Exclusions and Limitations
Carpals
28. 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)
New Patient
Surgical Package
Gender rule
29. Law passed by the federal government to prosecute cases of Medicaid fraud.
Civil Monetary Penalties Law (CMPL)
Undetermined
Relative Value Payment Schedules Method
Social Security Number
30. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Compression fracture
Undetermined
Unspecified nature
Health Insurance Portability and Accountability Act (HIPAA)
31. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Full ROM
Malignant
Fee Schedule
Ischium
32. Forms the sides of the cranium
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Polyp
Parietal Bones
Pubic bone
33. 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
-90 - Reference (Outside) Laboratory
Vesicle
Fee-for-Service
Tabular List (Volume 1)...
34. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
-99 - Multiple Modifiers
Unlisted Procedures Procedures
Tabular List (Volume 1)...
lunula
35. 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
Peer Review Organization (PRO)
Ulcermembranes
Category I Codes CPT
36. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Two triangular symbols (a
Long bones
HCPCS Level II codes (National Codes)
Sebaceous glands
37. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Rib Cage
Fiscal Intermediary
Past - family and social history (PFSH)
Assault
38. numbers 8-10 - are attached to the sternum by cartilage
Polyp
False ribs
Medicare
Health Care Financing Administration Common Procedure Coding System
39. 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).
Rib Cage
Medicare Claim Status
TRICARE
Chapters
40. 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)
Medicare
Categorically needy -MEDICAID
-99 - Multiple Modifiers
41. 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.
nonessential modifiers
Group Provider Number
sebaceous(oil) glands and the suddoriferous (sweat) glands
Wheal
42. is defined as one who has not received any medical services within the last three years.
New Patient
phalanges (phalanx.s)
Modifiers
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
43. 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.
Uncertain behavior
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Physician
Assault
44. 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
Pre-paid Health Plan
Fraud
Coding
Advance Beneficiary Notice
45. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
Chief complaint (CC)
Disability insurance
Radius
Vesicle
46. 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)
Suicide Attempt
Medicaid
Gender rule
47. The lower anterior part of the bone
Explanation of Benefits (EOB)
MEDICARE Part C
Pubic bone
Health Maintenance Organization (HMO)
48. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Medical Records
Inferior nasal conchae
Category III Codes CPT
New patient
49. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
MEDICAID COVERAGE
Gender rule
Relative Value Payment Schedules Method
MEDICARE Part C
50. 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
MEDICARE Part C
National Correct Coding Initiative (NCCI)
Accident
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period