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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. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Reasons for Documentation
Medicare
Retention of Medical Records
Birthday rule
2. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Rib Cage
Workers Compensation
Clean claim
Column 1/Column 2 (previously called Comprehensive/Component) Edits
3. make up part of the roof of the mouth
Flat bones
Palatine bones
Unlisted Procedures Procedures
stand-alone codes
4. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Explanation of Benefits (EOB)
Eligibility
Medical necessity
Nonparticipating physician
5. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Pathologic
Coding
History of present illness (HPI)
Neoplasm Table
6. solid - round or oval elevated lesion more than 1 cm in diameter
Clean claim
New patient
Pelvis
Nodule
7. The lower anterior part of the bone
Chapters
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Pubic bone
Mandible
8. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Vesicle
HCPCS Level II codes (National Codes)
Capitated Rates
MEDICARE Part A
9. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Personal Insurance
False Claims Act (FCA)
Ischium
Neoplasm Table
10. Benign growth extending from the surface of the mucous membrane
Ulcermembranes
Section 3 Index to External Causes of Injury (E codes)
Lipocyte
Polyp
11. 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....
There are two types of sweat glands
The St. Anthony Relative Value for Physicians (RVP)
Add-on codes
TRICARE PLANS
12. 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
Ischium
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Social Security Number
Wheal
13. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Fissure
stand-alone codes
Vomer
ulna
14. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Dirty claim
Section 3 Index to External Causes of Injury (E codes)
Pre-paid Health Plan
Neoplasm Table
15. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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16. 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.
Undetermined
Lacrimal bones
Pre-determination
Comminuted fracture
17. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Modifiers
sebaceous(oil) glands and the suddoriferous (sweat) glands
Section 3 Index to External Causes of Injury (E codes)
Long bones
18. solid - round or oval elevated lesion more than 1 cm in diameter
Rib Cage
Nodule
Eligibility
Reasons for Documentation
19. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
MEDICARE Part C
encounter form
Long bones
Melanin
20. .. lower jaw bone.
Mandible
The Current Procedural Terminology (CPT)
Civil Monetary Penalties Law (CMPL)
Alopecia
21. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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22. 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.
stand-alone codes
Employer Liability
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Vesicle
23. The main term in the index may by followed by terms within parenthesis.
Alphabetic Index (Volume 2)
Health practitioner
Health Care Financing Administration Common Procedure Coding System
Vesicle
24. 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
Lipocyte
Pre-certification
Gender rule
Coinsurance
25. 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
Medicare
Workers Compensation
Malignant
26. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Employer Identification Number (EIN)
Medical Records
HCPCS Level I codes
27. The poisoning was self-inflicted.
The Universal Claim Form
Suicide Attempt
-26 - Professional Component
Secondary malignancy
28. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
MEDICARE Part C
Reasons for Documentation
Malignant
Impetigo
29. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Rib Cage
Modifiers
Category III Codes CPT
-90 - Reference (Outside) Laboratory
30. 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
eponychium
The Current Procedural Terminology (CPT)
History of present illness (HPI)
31. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu
Blue Cross/Blue Shield Plans
Birthday rule
-32 - Mandated Services
essential modifiers
32. The cuticle at the lower part of the nail and this is sometimes referred to as the
eponychium
Vomer
Non-covered benefit
Workers Compensation
33. 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
Liability insurance
History of present illness (HPI)
Section 3 Index to External Causes of Injury (E codes)
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
upper appendicular skeleton
Impetigo
eponychium
Preferred Provider Organization (PPO)
35. 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
Indemnity Insurance
Pathologic
Employer Liability
MEDICARE Part A
36.
Inferior nasal conchae
Pre-certification
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Malignant
37. 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.
ulna
triangle (a
Alphabetic Index (Volume 2)
Vomer
38. - 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.
Coding
CPT SECTIONS.
MEDICARE Part B
Unauthorized benefit
39. 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
Neoplasm Table
Disability insurance
Mandible
40. 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.
-32 - Mandated Services
Civil Monetary Penalties Law (CMPL)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Inferior nasal conchae
41. requires investigation and needs further clarification.
Rejected claim
Impetigo
Fissure
triangle (a
42. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
ligaments
Fee Schedule
Categorically needy -MEDICAID
Hairline
43. 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.
Hypertension Table
Group practice
Chief complaint (CC)
HCPCS Level II codes (National Codes)
44. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Tabular List (Volume 1)...
-90 - Reference (Outside) Laboratory
Pre-certification
Category III Codes CPT
45. poisoning was inflicted by another person with intent to kill or injure
Melanin
Sphenoid Bones
Assault
Health Maintenance Organization (HMO)
46. The reason the patient came to see the physician.
Chief complaint (CC)
Pre-paid Health Plan
Contracted Rates with MCOs
Unspecified nature
47. 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
Limited ROM
Benign (hypertension)
Clean claim
48. Represent changes in the text or definition between the triangles.
circle with a line through it)
Impetigo
Two triangular symbols (a
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
49. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
Fissure
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Lipocyte
50. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Musculoskeletal System
Gender rule
The Good Samaritan Act
Radius