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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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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. 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
Electronic Claim
Health practitioner
Disability insurance
New Patient
2. Represents a new procedure or service code added since the previous edition of the manual.
Liability insurance
phalanges (phalanx.s)
Colles
bullet (a
3. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Impetigo
Remittance Advice
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
appendicular skeleton .
4. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Established patient
Malignant
Unspecified (hypertension)
Coding
5. 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.
Coordination of Benefits (COB)
Full ROM
Humerus
-32 - Mandated Services
6. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Chief complaint (CC)
Accident
Dirty claim
7. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Indemnity Insurance
Pre-authorization
Medicare
There are three layers to the skin
8. 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
upper appendicular skeleton
Paper Claim
Unspecified nature
Point-of-Service plan (POS)
9. Forms the anterior part of the skull and the forehead
Comminuted fracture
Frontal Bone
Palatine bones
Eligibility
10. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Location Methods
The Good Samaritan Act
Fissure
History of present illness (HPI)
11. 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
Health Care Financing Administration Common Procedure Coding System
Fraud
There are three layers to the skin
Established Patient
12. Is made up of the shoulder - collar - pelvic and arms and legs
Gender rule
appendicular skeleton .
Melanin
sebaceous(oil) glands and the suddoriferous (sweat) glands
13. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
The St. Anthony Relative Value for Physicians (RVP)
Established Patient
The Patient Care Partnership (Patient's Bill of Rights)
14. 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
Employer Liability
Subcategories
MEDICAID COVERAGE
Unspecified nature
15. 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
Palatine bones
The Current Procedural Terminology (CPT)
Peer Review Organization (PRO)
Blue Cross/Blue Shield Plans
16. forms the two lower sides of the cranium.
Fee Schedule
Pathologic
-50 - Bilateral Procedure
Temporal Bone
17. 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
Pre-authorization
Capitated Rates
Subcategories
phalanges (phalanx.s)
18. 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.
New Patient
Medicare Claim Status
Mandible
Pre-determination
19. Typically not used on the claim form unless the provider does not have an EIN.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Full ROM
Sebaceous glands
Social Security Number
20. A fracture of the epiphyseal plate in children.
Health practitioner
Medigap (Medicare Supplemental Insurance)
Salter-Harris
Category II Codes CPT
21. 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.
Flat bones
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Group practice
Civil Monetary Penalties Law (CMPL)
22. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Deductible
-51 - Multiple Procedures
Fissure
Column 1/Column 2 (previously called Comprehensive/Component) Edits
23. 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
Past - family and social history (PFSH)
Categorically needy -MEDICAID
Commercial Carriers
History of present illness (HPI)
24. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Pre-certification
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Assault
Category II Codes CPT
25. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
-51 - Multiple Procedures
Medicare Claim Status
Keratin
phalanges (phalanx.s)
26. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
The Good Samaritan Act
Point-of-Service plan (POS)
Benign (hypertension)
Rib Cage
27. 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
Eligibility
TRICARE
Pathologic
Surgical Package
28. 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.
Unspecified nature
Colles
Chief complaint (CC)
Group practice
29. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
Point-of-Service plan (POS)
axial skeleton
Category III Codes CPT
30. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Unspecified nature
There are two types of sweat glands
National Correct Coding Initiative (NCCI)
Sub classification
31. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Unauthorized benefit
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Sphenoid Bones
Primary malignancy
32. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
triangle (a
Fissure
Impacted
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
33. 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.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Section 3 Index to External Causes of Injury (E codes)
Lacrimal bones
Non-covered benefit
34. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Indemnity Insurance
Abuse
Outpatient
Full ROM
35. 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.
New patient
Review of Systems (ROS)
Full ROM
Workers Compensation
36. 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
Relative Value Payment Schedules Method
Impetigo
Health Maintenance Organization (HMO)
Colles
37. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran
HCPCS Level I codes
Patient Confidentiality
Fraud
Clearinghouse
38. 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.
Sphenoid Bones
Dirty claim
-26 - Professional Component
Benign (hypertension)
39. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Preferred Provider plan
Rejected claim
Unspecified (hypertension)
Long bones
40. Pre-determined set of benefits covered under one set annual fee.
Frontal Bone
New Patient
Hairline
Pre-paid Health Plan
41. 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.
Limited ROM
Compression fracture
Established Patient
Uncertain behavior
42. The physician must obtain this number in order to practice within a state.
Rib Cage
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Colles
State License Number
43. .. lower jaw bone.
Mandible
Rejected claim
The St. Anthony Relative Value for Physicians (RVP)
-99 - Multiple Modifiers
44. Describes the services billed and includes a breakdown of how the payment is determined
Fee-for-Service
itemized statement
Explanation of Benefits (EOB)
Fissure
45. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
-26 - Professional Component
Qualified diagnosis
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
46. Is one who has no contract with the health insurance plan.
Medically needy
Palatine bones
Group Provider Number
Nonparticipating physician
47. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Explanation of Benefits (EOB)
Abuse
There are three layers to the skin
co-payment
48. 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.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Fissure
Hypertension Table
triangle (a
49. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
MEDICARE Part B
Impetigo
Disability insurance
Commercial Carriers
50. 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.
Wheal
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Coding
Alopecia