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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. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
bullet (a
phalanges (phalanx.s)
Performing Provider Identification Number (PPIN)
Health Care Financing Administration Common Procedure Coding System
2. Any fracture occurring spontaneously as a result of disease.
Pathologic
Abuse
Rejected claim
Neoplasm Table
3. 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).
Malignant
Hypertension Table
Benign (hypertension)
Sections
4. Describes the services billed and includes a breakdown of how the payment is determined
Occipital Bone
Explanation of Benefits (EOB)
Unspecified (hypertension)
Fissure
5. Lower portion of the pelvic bone
Benign (hypertension)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Ischium
-32 - Mandated Services
6. 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
Comminuted fracture
Patient Confidentiality
Medical Records
The Good Samaritan Act
7. Is the upper arm bone.
MEDICARE Part B
Unlisted Procedures Procedures
Alopecia
Humerus
8. 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.
Inferior nasal conchae
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Physician
Compliance Regulations
9. 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'.
itemized statement
Pre-authorization
Inpatient
Keratin
10. 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
Carpals
Employer Identification Number (EIN)
Preferred Provider Organization (PPO)
lunula
11. Is a working diagnosis which is not yet established.
Carcinoma (Ca) in situ
Qualified diagnosis
Eligibility
Chief complaint (CC)
12. The lower anterior part of the bone
Pubic bone
The St. Anthony Relative Value for Physicians (RVP)
Musculoskeletal System
Location Methods
13. 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.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Inpatient
itemized statement
circle with a line through it)
14. 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.
Lipocyte
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Zygoma
Carpals
15. 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
Preferred Provider Organization (PPO)
Musculoskeletal System
Coinsurance
Spinal/Vertebral Column
16. 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
Two triangular symbols (a
Accident
Neoplasm Table
Add-on codes
17. 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
Health Care Financing Administration Common Procedure Coding System
TRICARE PLANS
Point-of-Service plan (POS)
Group Provider Number
18. the bone is crushed and or shattered.
Established patient
Greenstick
There are two types of sweat glands
Comminuted fracture
19. Represent changes in the text or definition between the triangles.
Pelvis
Two triangular symbols (a
Musculoskeletal System
Compression fracture
20. 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.'
Medical necessity
-90 - Reference (Outside) Laboratory
Fiscal Intermediary
Employee Liability
21. requires investigation and needs further clarification.
Abuse
Rejected claim
Capitated Rates
Preferred Provider Organization (PPO)
22. A fracture of the epiphyseal plate in children.
Salter-Harris
The Good Samaritan Act
Sub classification
phalanges (phalanx.s)
23. The fractured area of bone collapses on itself.
Evaluation and Management Review
Palatine bones
Vomer
Compression fracture
24. 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
The Integumentary System
Mutually Exclusive Edits
co-payment
Paper Claim
25. 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
Medicaid
Colles
Greenstick
26. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
Accident
Medigap (Medicare Supplemental Insurance)
Fraud
Inpatient
27. 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 -
Carcinoma (Ca) in situ
essential modifiers
Point-of-Service plan (POS)
Nodule
28. Make up part of the interior of the nose.
Inferior nasal conchae
Salter-Harris
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Hairline
29. The physician must obtain this number in order to practice within a state.
State License Number
CPT SECTIONS.
Pre-certification
There are two types of sweat glands
30. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Nonparticipating physician
The Good Samaritan Act
Social Security Number
Employee Liability
31. Consists of the skull - rib cage - and spine
MEDICARE Part B
Full ROM
axial skeleton
Unspecified (hypertension)
32. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Medicaid
Health Maintenance Organization (HMO)
Contracted Rates with MCOs
Medicare
33. Groove or crack like sore
Fissure
Medical necessity
Ischium
Group Insurance
34. 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
Pre-authorization
triangle (a
Section 3 Index to External Causes of Injury (E codes)
Neoplasm Table
35. 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
Explanation of Benefits (EOB)
There are three layers to the skin
New Patient
36. 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
-90 - Reference (Outside) Laboratory
Employer Liability
Alphabetic Index (Volume 2)
Paper Claim
37. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Sebaceous glands
-51 - Multiple Procedures
Keratin
Liability insurance
38. paired bones at the corner of each eye that cradle the tear ducts.
Birthday rule
Lacrimal bones
Personal Insurance
-50 - Bilateral Procedure
39. 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
Tabular List (Volume 1)...
Unlisted Procedures Procedures
Fraud
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
40. Numbers 1-7 - attach directly to the sternum in the front of the body.
Vomer
Relative Value Payment Schedules Method
Unlisted Procedures Procedures
true ribs
41. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H
sebaceous(oil) glands and the suddoriferous (sweat) glands
Category III Codes CPT
TRICARE
Outpatient
42. forms the two lower sides of the cranium.
Vesicle
Compliance Regulations
Temporal Bone
Health Care Financing Administration Common Procedure Coding System
43. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Greenstick
Benign
encounter form
Established patient
44. 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
Sub classification
phalanges (phalanx.s)
Primary malignancy
triangle (a
45. major skin pigment
-32 - Mandated Services
Melanin
Invalid claim
Sesamoid bones
46. 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
Non-covered benefit
Subcategories
Categories
Vesicle
47. The moon like white area at the base of the nail.
Parietal Bones
lunula
Unspecified (hypertension)
TRICARE
48. Consists of the skull - rib cage - and spine
History of present illness (HPI)
axial skeleton
No ROM
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
49. 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
Accept assignment
Preferred Provider Organization (PPO)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
False Claims Act (FCA)
50. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
Fee Schedule
Nodule
-90 - Reference (Outside) Laboratory