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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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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. Is when two insurance companies work together to coordinate payment of the benefits.
False Claims Act (FCA)
Coordination of Benefits (COB)
eponychium
phalanges (phalanx.s)
2. The reason the patient came to see the physician.
Malignant
Polyp
Chief complaint (CC)
No ROM
3. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Mutually Exclusive Edits
Tabular List (Volume 1)...
Polyp
Coordination of Benefits (COB)
4. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Surgical Package
Hypertension Table
Advance Beneficiary Notice
Inpatient
5. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Medical Records
The Good Samaritan Act
MEDICARE Part D
Review of Systems (ROS)
6. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Category II Codes CPT
Health Care Financing Administration Common Procedure Coding System
Coding
Fiscal Intermediary
7. 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.
Social Security Number
Electronic Claim
triangle (a
Medical Records
8. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Consultation
Group practice
Collagen
-90 - Reference (Outside) Laboratory
9. 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.
Dirty claim
Carpals
Ethmoid Bone
Lipocyte
10. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
eponychium
Preferred Provider Organization (PPO)
Accept assignment
MEDICARE Part C
11. 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
Category I Codes CPT
Capitated Rates
Medicare
Non-covered benefit
12. 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
Radius
Preferred Provider Organization (PPO)
Retention of Medical Records
Chapters
13. '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
Employee Liability
Outpatient
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Unspecified nature
14. 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
National Correct Coding Initiative (NCCI)
Neoplasm Table
Peer Review Organization (PRO)
Limited ROM
15. Is made up of the shoulder - collar - pelvic and arms and legs
Unspecified nature
appendicular skeleton .
Add-on codes
Carpals
16. 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
Chapters
Commercial Carriers
Employer Liability
Section 3 Index to External Causes of Injury (E codes)
17. 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
Gender rule
Alopecia
Outpatient
Multigravida
18. 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
Accident
Categorically needy -MEDICAID
-50 - Bilateral Procedure
Categories
19. 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
Humerus
Group Provider Number
Consultation
-26 - Professional Component
20. is a traumatic injury to a joint involving the soft tissue.
Physician
Chapters
sprain
Compliance Regulations
21. 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
Neoplasm Table
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Birthday rule
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
22. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Category I Codes CPT
Physician
Peer Review Organization (PRO)
Preferred Provider plan
23. 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.
phalanges (phalanx.s)
co-payment
Personal Insurance
Eligibility
24. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Section 3 Index to External Causes of Injury (E codes)
Secondary malignancy
Tabular List (Volume 1)...
nonessential modifiers
25. A fat cell
Rejected claim
Lipocyte
Radius
Pathologic
26. poisoning was inflicted by another person with intent to kill or injure
Fissure
bullet (a
Assault
Secondary malignancy
27. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Medical Records
Hairline
true ribs
Macule
28. 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.
CPT SECTIONS.
Malignant
Category III Codes CPT
Peer Review Organization (PRO)
29. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Unspecified (hypertension)
State License Number
MEDICAID COVERAGE
30. 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
Commercial Carriers
Category III Codes CPT
itemized statement
The Current Procedural Terminology (CPT)
31. Is the lateral lower arm bone (in line with the thumb).
Colles
Deductible
Carcinoma (Ca) in situ
Radius
32. are small with irregular shapes. They are found in the wrist and ankle.
Hairline
Medical necessity
Uncertain behavior
Short bones
33. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Subcategories
sprain
ulna
MEDICARE Part A
34. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Peer Review Organization (PRO)
Employee Liability
Malignant
Suicide Attempt
35. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.
Group Provider Number
Modifiers
Chapters
Coinsurance
36. 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.
Non-covered benefit
Group Provider Number
-26 - Professional Component
Established Patient
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)
Surgical Package
ligaments
False Claims Act (FCA)
co-payment
38. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
CPT SECTIONS.
Colles
39. 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.
-90 - Reference (Outside) Laboratory
Electronic Claim
Health Care Financing Administration Common Procedure Coding System
Non-covered benefit
40. 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.
Vesicle
essential modifiers
Group practice
CPT SECTIONS.
41. 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
Flat bones
Neoplasm Table
Nonparticipating physician
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
42. The bone is broken and pierces an internal organ
Complicated
lunula
Comminuted fracture
Inpatient
43. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
-50 - Bilateral Procedure
Sphenoid Bones
New Patient
Keratin
44. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Pelvis
sprain
Medically needy
Vomer
45. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Chapters
Column 1/Column 2 (previously called Comprehensive/Component) Edits
-50 - Bilateral Procedure
46. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
The Integumentary System
encounter form
Dirty claim
47. 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.
The Universal Claim Form
Malignant
-26 - Professional Component
Clean claim
48. 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.
Pre-certification
The Integumentary System
Medically needy
Group practice
49. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Peer Review Organization (PRO)
Two triangular symbols (a
Personal Insurance
stand-alone codes
50. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
ulna
itemized statement
Disability insurance
Chief complaint
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