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Test your basic knowledge |
Medical Billing And Coding Vocab
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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. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Alphabetic Index (Volume 2)
Colles
Performing Provider Identification Number (PPIN)
Indemnity Insurance
2. 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
Zygoma
MEDICARE Part C
Rejected claim
co-payment
3. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
Established Patient
MEDICARE Part B
Inferior nasal conchae
National Correct Coding Initiative (NCCI)
4. 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'.
Evaluation and Management Review
Pre-authorization
Personal Insurance
Pre-determination
5. 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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6. 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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7. 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
Albino
Fiscal Intermediary
Pre-determination
8. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
The Universal Claim Form
Sesamoid bones
HCPCS Level II codes (National Codes)
Sub classification
9. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
MEDICARE Part B
Evaluation and Management Review
Tabular List (Volume 1)...
Categories
10. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
MEDICAID COVERAGE
Participating physician
Lacrimal bones
Nonparticipating physician
11. 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'.
Complicated
New Patient
Pre-authorization
The St. Anthony Relative Value for Physicians (RVP)
12. 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
Patient Confidentiality
Consultation
Medicare
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
13. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Clearinghouse
Unlisted Procedures Procedures
Fee-for-Service
nonessential modifiers
14. 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:
Lipocyte
TRICARE PLANS
Hypertension Table
-26 - Professional Component
15. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
HCPCS Level I codes
Pre-determination
essential modifiers
State License Number
16. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
Workers Compensation
Established patient
False Claims Act (FCA)
lunula
17. 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
Pre-paid Health Plan
Clearinghouse
Categorically needy -MEDICAID
Sphenoid Bones
18. 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
Alphabetic Index (Volume 2)
Medicare Claim Status
-26 - Professional Component
Electronic Claim
19. Produce secretions that allow the body to be moisturized or cooled.
essential modifiers
ulna
Add-on codes
sebaceous(oil) glands and the suddoriferous (sweat) glands
20. 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.
Nodule
Inpatient
Clean claim
History
21. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Compliance Regulations
Tabular List (Volume 1)...
bullet (a
22. Represent changes in the text or definition between the triangles.
False ribs
ligaments
Two triangular symbols (a
Uncertain behavior
23. Superior and widest bone
Participating physician
sebaceous(oil) glands and the suddoriferous (sweat) glands
Pelvis
Fraud
24. Is one who has no contract with the health insurance plan.
stand-alone codes
Point-of-Service plan (POS)
Primary malignancy
Nonparticipating physician
25. 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
Humerus
Inpatient
Rejected claim
Birthday rule
26. Discolored - flat lesion (freckles - tattoo marks)
eponychium
Suicide Attempt
appendicular skeleton .
Macule
27. 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.
Radius
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Section 3 Index to External Causes of Injury (E codes)
Add-on codes
28. 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....
The St. Anthony Relative Value for Physicians (RVP)
Exclusions and Limitations
Assault
Inferior nasal conchae
29. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Peer Review Organization (PRO)
Employer Identification Number (EIN)
Group Provider Number
Nodule
30. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
-90 - Reference (Outside) Laboratory
Pathologic
31. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)
co-payment
Medical Records
Location Methods
Hairline
32. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
essential modifiers
Maxilla
The Universal Claim Form
Primary malignancy
33. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu
-51 - Multiple Procedures
HCPCS Level II codes (National Codes)
Neoplasm Table
Category III Codes CPT
34. Contains complete - necessary information - but is incorrect or illogical in some way.
Impacted
Invalid claim
Impacted
essential modifiers
35. The bone is broken and pierces an internal organ
Complicated
bullet (a
Fee Schedule
MEDICARE Part C
36. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
ligaments
New patient
Pre-certification
Keratin
37. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
circle with a line through it)
stand-alone codes
Qualified diagnosis
encounter form
38. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Past - family and social history (PFSH)
Malignant
Keratin
Fee Schedule
39. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
upper appendicular skeleton
Peer Review Organization (PRO)
Full ROM
Vesicle
40. Is when two insurance companies work together to coordinate payment of the benefits.
MEDICARE Part D
Limited ROM
Coordination of Benefits (COB)
upper appendicular skeleton
41. .. lower jaw bone.
The Current Procedural Terminology (CPT)
Mandible
Category I Codes CPT
HCPCS Level II codes (National Codes)
42. 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.
Spinal/Vertebral Column
Section 3 Index to External Causes of Injury (E codes)
Personal Insurance
Paper Claim
43. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Birthday rule
Group Provider Number
Limited ROM
Gangrene
44. 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.
Modifiers
Nonparticipating physician
Gangrene
MEDICARE Part D
45. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
Health Insurance Portability and Accountability Act (HIPAA)
Location Methods
Categorically needy -MEDICAID
Preferred Provider Organization (PPO)
46. 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....
Impetigo
Outpatient
Suicide Attempt
Established patient
47. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Albino
Melanin
Column 1/Column 2 (previously called Comprehensive/Component) Edits
48. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Subcategories
Remittance Advice
Birthday rule
Workers Compensation
49. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
MEDICARE Part C
Preferred Provider plan
Fee Schedule
50. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
Categorically needy -MEDICAID
Gender rule
Nodule
Outpatient