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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. 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
Compression fracture
Employee Liability
Clean claim
Sub classification
2. 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.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Keratin
Point-of-Service plan (POS)
3. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Ischium
Fee-for-Service
Sesamoid bones
There are three layers to the skin
4. Is the upper arm bone.
Humerus
The Current Procedural Terminology (CPT)
Neoplasm Table
Invalid claim
5. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Evaluation and Management Review
Mutually Exclusive Edits
Tabular List (Volume 1)...
Impetigo
6. 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.
Greenstick
Group Provider Number
Albino
Employee Liability
7. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Medical Records
Peer Review Organization (PRO)
Flat bones
Macule
8. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
The Current Procedural Terminology (CPT)
Gender rule
Vesicle
National Correct Coding Initiative (NCCI)
9. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
upper appendicular skeleton
Compliance Regulations
False ribs
Past - family and social history (PFSH)
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
Health practitioner
Fee-for-Service
Sesamoid bones
Preferred Provider Organization (PPO)
11. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran
Remittance Advice
Categories
Vomer
Clearinghouse
12. major skin pigment
Benign
Categorically needy -MEDICAID
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Melanin
13. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Coordination of Benefits (COB)
Clean claim
Pathologic
Long bones
14. 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
Two triangular symbols (a
Compression fracture
Compliance Regulations
15. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Neoplasm Table
There are two types of sweat glands
Macule
Reasons for Documentation
16. is a traumatic injury to a joint involving the soft tissue.
Categories
Electronic Claim
sprain
Column 1/Column 2 (previously called Comprehensive/Component) Edits
17. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
The Good Samaritan Act
Unauthorized benefit
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Participating physician
18. 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.
sprain
Dirty claim
Pre-authorization
Limited ROM
19. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Assault
Employer Identification Number (EIN)
-50 - Bilateral Procedure
Occipital Bone
20. Law passed by the federal government to prosecute cases of Medicaid fraud.
Civil Monetary Penalties Law (CMPL)
Nonparticipating physician
The Good Samaritan Act
Collagen
21. Noninvasive - non-spreading - nonmalignant
Modifiers
Benign
Fee Schedule
MEDICARE Part C
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
Birthday rule
Invalid claim
Musculoskeletal System
Full ROM
23. Absence of hair from areas where it normally grows
Pre-certification
Inpatient
Two triangular symbols (a
Alopecia
24. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Wheal
Pubic bone
Medicare Claim Status
Colles
25. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
Fee-for-Service
Short bones
Rejected claim
26. Describes the services billed and includes a breakdown of how the payment is determined
Rejected claim
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Explanation of Benefits (EOB)
co-payment
27. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
CPT SECTIONS.
Review of Systems (ROS)
sprain
MEDICARE Part C
28. The physician must obtain this number in order to practice within a state.
Alopecia
Pubic bone
Mandible
State License Number
29. Forms the sides of the cranium
The Patient Care Partnership (Patient's Bill of Rights)
Accident
Parietal Bones
Gender rule
30. The poisoning was self-inflicted.
Suicide Attempt
Mandible
Add-on codes
Neoplasm Table
31. 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
Surgical Package
CPT SECTIONS.
Rib Cage
Lacrimal bones
32. make up part of the roof of the mouth
sprain
Subcategories
Category II Codes CPT
Palatine bones
33. The bone is broken and pierces an internal organ
Medicare
Complicated
Social Security Number
Pre-determination
34. 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
MEDICAID COVERAGE
Liability insurance
Fee-for-Service
Full ROM
35. 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
Advance Beneficiary Notice
Group Insurance
bullet (a
TRICARE PLANS
36. Discolored - flat lesion (freckles - tattoo marks)
Macule
Retention of Medical Records
Pre-paid Health Plan
Full ROM
37. 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
Greenstick
Humerus
TRICARE PLANS
New patient
38. 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
Albino
Non-covered benefit
-32 - Mandated Services
Health Maintenance Organization (HMO)
39. forms the two lower sides of the cranium.
HCPCS Level I codes
Temporal Bone
Dirty claim
Unspecified (hypertension)
40. The moon like white area at the base of the nail.
Medically needy
MEDICARE Part A
lunula
Maxilla
41. 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.
Fee-for-Service
Lipocyte
Medicaid
Birthday rule
42. 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
Inpatient
Fissure
Preferred Provider Organization (PPO)
Category III Codes CPT
43. Is one who has no contract with the health insurance plan.
Mandible
Multigravida
Blue Cross/Blue Shield Plans
Nonparticipating physician
44. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Modifiers
Social Security Number
Flat bones
Vomer
45. Deficient in pigment (melanin)
Pelvis
Salter-Harris
Albino
Location Methods
46. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Chapters
essential modifiers
Comminuted fracture
Contracted Rates with MCOs
47. A fracture of the epiphyseal plate in children.
Fee Schedule
Salter-Harris
MEDICARE Part A
Pre-certification
48. Represents a new procedure or service code added since the previous edition of the manual.
Preferred Provider Organization (PPO)
Fee Schedule
bullet (a
Rejected claim
49. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Clearinghouse
Group Insurance
Pre-authorization
50. 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
Group Provider Number
Fiscal Intermediary
Uncertain behavior