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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. open sore on the skin or mucous
Fiscal Intermediary
Location Methods
Lacrimal bones
Ulcermembranes
2. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Gangrene
Impacted
Assault
Spinal/Vertebral Column
3. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
Preferred Provider Organization (PPO)
Pre-paid Health Plan
Non-covered benefit
Tabular List (Volume 1)...
4. The fractured area of bone collapses on itself.
New patient
Compression fracture
true ribs
The Universal Claim Form
5. 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
Health Care Financing Administration Common Procedure Coding System
Sebaceous glands
Health Insurance Portability and Accountability Act (HIPAA)
Benign
6. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Paper Claim
Limited ROM
Category III Codes CPT
Polyp
7. are small with irregular shapes. They are found in the wrist and ankle.
Dirty claim
Short bones
MEDICARE Part C
Social Security Number
8. Are composed of three-digit codes representing a single disease or condition.
TRICARE PLANS
Categories
essential modifiers
National Correct Coding Initiative (NCCI)
9. 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..
HCPCS Level II codes (National Codes)
Musculoskeletal System
Short bones
Explanation of Benefits (EOB)
10. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Capitated Rates
Sub classification
Pre-authorization
Ulcermembranes
11. This is a set of information the physician gathers from the patient regarding the following:
Established patient
Health practitioner
-90 - Reference (Outside) Laboratory
History
12. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Nonparticipating physician
Chief complaint
Dirty claim
TRICARE PLANS
13. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
New Patient
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Sub classification
14. Further classified as to primary - secondary - or carcinoma in situ.
Workers Compensation
Medical Records
Liability insurance
Malignant
15. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
Primary malignancy
The Current Procedural Terminology (CPT)
Hairline
Capitated Rates
16. 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.
sprain
Personal Insurance
Compliance Regulations
Sections
17. is a traumatic injury to a joint involving the soft tissue.
sprain
Non-covered benefit
Carpals
Coordination of Benefits (COB)
18. 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.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Mandible
eponychium
Personal Insurance
19. 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
Category I Codes CPT
Inpatient
Remittance Advice
Fee-for-Service
20. Is the qualifying factor or factors that must be met before a patient receives benefits.
Paper Claim
premium
Eligibility
CPT SECTIONS.
21. Forms the anterior part of the skull and the forehead
Frontal Bone
Coinsurance
Maxilla
Medical Records
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
Ethmoid Bone
Patient Confidentiality
Medigap (Medicare Supplemental Insurance)
Complicated
23. 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
Ulcermembranes
Unspecified (hypertension)
Health Maintenance Organization (HMO)
24. Produce secretions that allow the body to be moisturized or cooled.
The Integumentary System
Birthday rule
Patient Confidentiality
sebaceous(oil) glands and the suddoriferous (sweat) glands
25. 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.
Pre-determination
Limited ROM
Section 3 Index to External Causes of Injury (E codes)
Pelvis
26. 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
Health Maintenance Organization (HMO)
Tabular List (Volume 1)...
Short bones
Paper Claim
27. The physician must obtain this number in order to practice within a state.
State License Number
Clearinghouse
-51 - Multiple Procedures
Location Methods
28. The cuticle at the lower part of the nail and this is sometimes referred to as the
Alopecia
eponychium
Reasons for Documentation
Unauthorized benefit
29. 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.
MEDICARE Part A
Carpals
Gender rule
Rib Cage
30. 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
Fee Schedule
Maxilla
Location Methods
31. Lower portion of the pelvic bone
Impacted
Ischium
History of present illness (HPI)
Exclusions and Limitations
32. 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.
Salter-Harris
Alphabetic Index (Volume 2)
-26 - Professional Component
CPT SECTIONS.
33. is defined as one who has not received any medical services within the last three years.
Medicaid
Pelvis
New Patient
Established patient
34. 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.
Limited ROM
Coding
Fissure
New patient
35. 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.
-32 - Mandated Services
Collagen
Hypertension Table
Inpatient
36. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Relative Value Payment Schedules Method
Commercial Carriers
Liability insurance
Ethmoid Bone
37. 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)
Undetermined
Liability insurance
Musculoskeletal System
co-payment
38. numbers 8-10 - are attached to the sternum by cartilage
Capitated Rates
Unlisted Procedures Procedures
False ribs
Comminuted fracture
39. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -
essential modifiers
Medical necessity
Liability insurance
circle with a line through it)
40. Cheekbone
HCPCS Level I codes
Zygoma
Subcategories
Comminuted fracture
41. anterior to the temporal bones.
-26 - Professional Component
Humerus
Sphenoid Bones
Salter-Harris
42. 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
Clean claim
HCPCS Level II codes (National Codes)
Established patient
43. most synarthroses are immovable joints held together by fibrous tissue.
Abuse
Sebaceous glands
circle with a line through it)
No ROM
44. 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
Fissure
Capitated Rates
axial skeleton
Categorically needy -MEDICAID
45. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Electronic Claim
The Current Procedural Terminology (CPT)
Chief complaint (CC)
Secondary malignancy
46. 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
Categorically needy -MEDICAID
False ribs
Deductible
Pre-determination
47. Typically not used on the claim form unless the provider does not have an EIN.
Unauthorized benefit
Explanation of Benefits (EOB)
Category III Codes CPT
Social Security Number
48. 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.
Coding
Retention of Medical Records
Remittance Advice
Vesicle
49. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
False ribs
Greenstick
Alopecia
Column 1/Column 2 (previously called Comprehensive/Component) Edits
50. .. lower jaw bone.
Sections
eponychium
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Mandible