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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 a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Evaluation and Management Review
Point-of-Service plan (POS)
Advance Beneficiary Notice
Exclusions and Limitations
2. Forms the anterior part of the skull and the forehead
Zygoma
Frontal Bone
essential modifiers
Explanation of Benefits (EOB)
3. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Keratin
Temporal Bone
Physician
Unspecified nature
4. 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
Gangrene
bullet (a
appendicular skeleton .
5. 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
Employee Liability
Parietal Bones
encounter form
Workers Compensation
6. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Carcinoma (Ca) in situ
Long bones
Category II Codes CPT
Ethmoid Bone
7. Is when two insurance companies work together to coordinate payment of the benefits.
Deductible
Coordination of Benefits (COB)
Two triangular symbols (a
Indemnity Insurance
8. poisoning was inflicted by another person with intent to kill or injure
Medicare Claim Status
Assault
Retention of Medical Records
Employer Identification Number (EIN)
9. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Primary malignancy
Albino
Abuse
Column 1/Column 2 (previously called Comprehensive/Component) Edits
10. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
Disability insurance
Mandible
Complicated
MEDICARE Part D
11. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Vomer
Neoplasm Table
Suicide Attempt
-50 - Bilateral Procedure
12. 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.
Abuse
-26 - Professional Component
There are two types of sweat glands
HCPCS Level II codes (National Codes)
13. the bone is crushed and or shattered.
Comminuted fracture
Pre-paid Health Plan
upper appendicular skeleton
Unauthorized benefit
14. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Pubic bone
Retention of Medical Records
Employer Identification Number (EIN)
The Good Samaritan Act
15. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
Indemnity Insurance
upper appendicular skeleton
Long bones
Medical necessity
16. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Deductible
HCPCS Level II codes (National Codes)
Medicare Claim Status
Surgical Package
17. Are conditions - situations - and services not covered by the insurance carrier.
History
-50 - Bilateral Procedure
Section 3 Index to External Causes of Injury (E codes)
Exclusions and Limitations
18. Discolored - flat lesion (freckles - tattoo marks)
Macule
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Group practice
Relative Value Payment Schedules Method
19. 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
Evaluation and Management Review
Accident
Unique Provider Identification Number (UPIN)
False Claims Act (FCA)
20. 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
Explanation of Benefits (EOB)
Chief complaint (CC)
21. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
A plus sign (+)
Medically needy
Medicaid
Two triangular symbols (a
22. 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
Health practitioner
Paper Claim
The Patient Care Partnership (Patient's Bill of Rights)
Birthday rule
23. The reason the patient came to see the physician.
Accept assignment
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
axial skeleton
Chief complaint (CC)
24. 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
Inpatient
Macule
Comminuted fracture
25. 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
sebaceous(oil) glands and the suddoriferous (sweat) glands
Frontal Bone
Polyp
Blue Cross/Blue Shield Plans
26. 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
Hypertension Table
Hypertension Table
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
stand-alone codes
27. 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....
Established Patient
Established patient
Past - family and social history (PFSH)
The St. Anthony Relative Value for Physicians (RVP)
28. The lower anterior part of the bone
Point-of-Service plan (POS)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Radius
Pubic bone
29. 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
Paper Claim
Flat bones
encounter form
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
30. forms the roof of the nasal cavity.
Ethmoid Bone
MEDICARE Part C
MEDICARE Part A
Pathologic
31. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
MEDICARE Part A
Accept assignment
Group Provider Number
32. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Comminuted fracture
Evaluation and Management Review
Impetigo
Neoplasm Table
33. Is the qualifying factor or factors that must be met before a patient receives benefits.
Maxilla
Blue Cross/Blue Shield Plans
Medicaid
Eligibility
34. 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
-50 - Bilateral Procedure
Birthday rule
Malignant
Health Maintenance Organization (HMO)
35. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Spinal/Vertebral Column
Remittance Advice
Contracted Rates with MCOs
Tabular List (Volume 1)...
36. Is when two insurance companies work together to coordinate payment of the benefits.
Invalid claim
Health practitioner
Fraud
Coordination of Benefits (COB)
37. 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.
-26 - Professional Component
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Modifiers
Health practitioner
38. Produce secretions that allow the body to be moisturized or cooled.
Invalid claim
Category I Codes CPT
sebaceous(oil) glands and the suddoriferous (sweat) glands
Preferred Provider plan
39. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Zygoma
upper appendicular skeleton
Long bones
Malignant
40. 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
Assault
premium
New Patient
Categorically needy -MEDICAID
41. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Category II Codes CPT
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Wheal
Capitated Rates
42. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Carcinoma (Ca) in situ
Lipocyte
There are three layers to the skin
HCPCS Level I codes
43. paired bones at the corner of each eye that cradle the tear ducts.
Fissure
Personal Insurance
Lacrimal bones
bullet (a
44. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Inferior nasal conchae
-99 - Multiple Modifiers
Accept assignment
Unlisted Procedures Procedures
45. 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.
Physician
The Patient Care Partnership (Patient's Bill of Rights)
-32 - Mandated Services
encounter form
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....
Established patient
Section 3 Index to External Causes of Injury (E codes)
appendicular skeleton .
Secondary malignancy
47. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Primary malignancy
MEDICARE Part B
Rib Cage
-51 - Multiple Procedures
48. Contains complete - necessary information - but is incorrect or illogical in some way.
Reasons for Documentation
-99 - Multiple Modifiers
Invalid claim
upper appendicular skeleton
49. Lower portion of the pelvic bone
Health Care Financing Administration Common Procedure Coding System
Rib Cage
Accident
Ischium
50. 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.
Complicated
triangle (a
Carpals
Macule