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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. Small collection of clear fluid;blister
Collagen
Physician
Vesicle
Chief complaint
2. 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
Nonparticipating physician
encounter form
Carpals
Paper Claim
3. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual
HCPCS Level I codes
Fee Schedule
Provider Identification Number (PIN)
CPT SECTIONS.
4. The main term in the index may by followed by terms within parenthesis.
Greenstick
Preferred Provider Organization (PPO)
Alphabetic Index (Volume 2)
Coinsurance
5. Any fracture occurring spontaneously as a result of disease.
Medicare Claim Status
Alopecia
Pathologic
Uncertain behavior
6. Groove or crack like sore
Retention of Medical Records
Reasons for Documentation
Vomer
Fissure
7. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
itemized statement
eponychium
Malignant
Primary malignancy
8. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
Workers Compensation
Fissure
Humerus
Health practitioner
9. Are composed of three-digit codes representing a single disease or condition.
Categories
Medicare Claim Status
Maxilla
Subcategories
10. 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
HCPCS Level II codes (National Codes)
Workers Compensation
Blue Cross/Blue Shield Plans
The Good Samaritan Act
11. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
Wheal
Clearinghouse
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Gender rule
12. 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
Undetermined
Categorically needy -MEDICAID
Mandible
Fraud
13. A pregnant woman who has had at least one previous pregnancy.
Multigravida
History of present illness (HPI)
HCPCS Level I codes
Macule
14. 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
phalanges (phalanx.s)
Liability insurance
Health Maintenance Organization (HMO)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
15. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
Coordination of Benefits (COB)
Employee Liability
The Integumentary System
Spinal/Vertebral Column
16. 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
Fissure
Non-covered benefit
Birthday rule
Subcategories
17. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
phalanges (phalanx.s)
appendicular skeleton .
Preferred Provider plan
axial skeleton
18. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
Relative Value Payment Schedules Method
Unauthorized benefit
-90 - Reference (Outside) Laboratory
MEDICARE Part D
19. 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
Spinal/Vertebral Column
Unique Provider Identification Number (UPIN)
Flat bones
Primary malignancy
20. Is when two insurance companies work together to coordinate payment of the benefits.
Accident
Inpatient
Coordination of Benefits (COB)
History of present illness (HPI)
21. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
HCPCS Level II codes (National Codes)
-51 - Multiple Procedures
History of present illness (HPI)
Benign
22. Forms the sides of the cranium
Occipital Bone
Parietal Bones
Advance Beneficiary Notice
Salter-Harris
23. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Hairline
Employer Identification Number (EIN)
Nodule
Albino
24. This is a set of information the physician gathers from the patient regarding the following:
Blue Cross/Blue Shield Plans
itemized statement
History
Humerus
25. 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 -
There are two types of sweat glands
circle with a line through it)
Commercial Carriers
essential modifiers
26. Law passed by the federal government to prosecute cases of Medicaid fraud.
Pathologic
Civil Monetary Penalties Law (CMPL)
Location Methods
State License Number
27. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Explanation of Benefits (EOB)
Health Maintenance Organization (HMO)
Health Maintenance Organization (HMO)
Coding
28. are small with irregular shapes. They are found in the wrist and ankle.
MEDICARE Part A
sprain
Short bones
Physician
29. Deficient in pigment (melanin)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
true ribs
Disability insurance
Albino
30. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Accept assignment
sebaceous(oil) glands and the suddoriferous (sweat) glands
Consultation
Modifiers
31. A fat cell
Multigravida
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Lipocyte
Past - family and social history (PFSH)
32. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
Invalid claim
Remittance Advice
Location Methods
Group Insurance
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
Neoplasm Table
appendicular skeleton .
Workers Compensation
ulna
34. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Ethmoid Bone
Musculoskeletal System
Greenstick
-99 - Multiple Modifiers
35. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Employer Identification Number (EIN)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Frontal Bone
Gender rule
36. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
appendicular skeleton .
Chapters
Mandible
encounter form
37. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Suicide Attempt
Participating physician
Tabular List (Volume 1)...
Multigravida
38. 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).
Participating physician
Coordination of Benefits (COB)
Sections
Salter-Harris
39. 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.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Musculoskeletal System
Employer Identification Number (EIN)
Birthday rule
40. This modifier is used when the same procedure is performed on a mirror-image part of the body..
-50 - Bilateral Procedure
There are three layers to the skin
circle with a line through it)
Unauthorized benefit
41. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Categorically needy -MEDICAID
Commercial Carriers
Long bones
42. Represents a new procedure or service code added since the previous edition of the manual.
Rib Cage
Frontal Bone
Consultation
bullet (a
43. Groove or crack like sore
Commercial Carriers
Fissure
Tabular List (Volume 1)...
MEDICARE Part D
44. 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'.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
triangle (a
Pre-authorization
Suicide Attempt
45. The reason the patient came to see the physician.
Electronic Claim
Medigap (Medicare Supplemental Insurance)
Chief complaint (CC)
Impacted
46. 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
Compliance Regulations
TRICARE PLANS
Patient Confidentiality
Categories
47. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Impetigo
Relative Value Payment Schedules Method
Pathologic
encounter form
48. 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.
Indemnity Insurance
Medicare Claim Status
phalanges (phalanx.s)
MEDICARE Part A
49. 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
The Current Procedural Terminology (CPT)
Sebaceous glands
Retention of Medical Records
50. 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.
The Integumentary System
New Patient
Liability insurance
Category III Codes CPT