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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. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
The Good Samaritan Act
New patient
Assault
Clean claim
2. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Chief complaint
Sections
itemized statement
New patient
3. Typically not used on the claim form unless the provider does not have an EIN.
Sections
Clearinghouse
Group Provider Number
Social Security Number
4. Describes the services billed and includes a breakdown of how the payment is determined
Secondary malignancy
Explanation of Benefits (EOB)
Impacted
Surgical Package
5. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
MEDICAID COVERAGE
Review of Systems (ROS)
Category II Codes CPT
Explanation of Benefits (EOB)
6. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Physician
Location Methods
MEDICARE Part B
Group Insurance
7. 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.
Fraud
Column 1/Column 2 (previously called Comprehensive/Component) Edits
False ribs
National Correct Coding Initiative (NCCI)
8. 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
Clearinghouse
TRICARE PLANS
Patient Confidentiality
-51 - Multiple Procedures
9. male of household is primary payer
Gender rule
Category II Codes CPT
Physician
appendicular skeleton .
10. 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
Health practitioner
Alphabetic Index (Volume 2)
Ischium
Alopecia
11. Consists of the skull - rib cage - and spine
axial skeleton
Mandible
lunula
Impetigo
12. Contains complete - necessary information - but is incorrect or illogical in some way.
Collagen
CPT SECTIONS.
Invalid claim
Nodule
13. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Alphabetic Index (Volume 2)
Unauthorized benefit
Coding
Employer Identification Number (EIN)
14. 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.
Advance Beneficiary Notice
triangle (a
Participating physician
Modifiers
15. poisoning was inflicted by another person with intent to kill or injure
Advance Beneficiary Notice
Fee Schedule
Assault
essential modifiers
16. .. lower jaw bone.
Medicaid
Mandible
Melanin
Tabular List (Volume 1)...
17. The physician must obtain this number in order to practice within a state.
Maxilla
Palatine bones
The Integumentary System
State License Number
18. 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
Non-covered benefit
sebaceous(oil) glands and the suddoriferous (sweat) glands
Relative Value Payment Schedules Method
Fee-for-Service
19. Represent changes in the text or definition between the triangles.
Primary malignancy
Two triangular symbols (a
State License Number
Performing Provider Identification Number (PPIN)
20. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
ligaments
Advance Beneficiary Notice
CPT SECTIONS.
Musculoskeletal System
21. 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.
Carpals
Health Care Financing Administration Common Procedure Coding System
Compression fracture
Occipital Bone
22. 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.
TRICARE
Group practice
State License Number
Carpals
23. 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
Fee Schedule
Keratin
The St. Anthony Relative Value for Physicians (RVP)
Inpatient
24. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Preferred Provider Organization (PPO)
Zygoma
Two triangular symbols (a
25. Forms the anterior part of the skull and the forehead
Nodule
Reasons for Documentation
Frontal Bone
Medigap (Medicare Supplemental Insurance)
26. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Section 3 Index to External Causes of Injury (E codes)
Surgical Package
-99 - Multiple Modifiers
Advance Beneficiary Notice
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
Invalid claim
MEDICARE Part C
Non-covered benefit
Capitated Rates
28. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
Fee Schedule
Sebaceous glands
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Personal Insurance
29. 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
Lipocyte
Palatine bones
Workers Compensation
Gangrene
30. Is when two insurance companies work together to coordinate payment of the benefits.
Contracted Rates with MCOs
Chief complaint
Coordination of Benefits (COB)
Workers Compensation
31. Small collection of clear fluid;blister
Compression fracture
lunula
Vesicle
stand-alone codes
32. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Pre-authorization
Tabular List (Volume 1)...
essential modifiers
Column 1/Column 2 (previously called Comprehensive/Component) Edits
33. Small collection of clear fluid;blister
Neoplasm Table
Vesicle
Greenstick
Lipocyte
34. 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
Alphabetic Index (Volume 2)
Explanation of Benefits (EOB)
HCPCS Level II codes (National Codes)
35. Forms the anterior part of the skull and the forehead
State License Number
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Electronic Claim
Frontal Bone
36. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
National Correct Coding Initiative (NCCI)
bullet (a
Point-of-Service plan (POS)
37. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
Compression fracture
Occipital Bone
-32 - Mandated Services
Invalid claim
38. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Pre-certification
Gangrene
Health Insurance Portability and Accountability Act (HIPAA)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
39. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
Secondary malignancy
Unlisted Procedures Procedures
Compression fracture
40. Consists of the skull - rib cage - and spine
National Correct Coding Initiative (NCCI)
Pre-determination
upper appendicular skeleton
axial skeleton
41. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Health Insurance Portability and Accountability Act (HIPAA)
Nodule
-32 - Mandated Services
stand-alone codes
42. This is the inventory of the constitutional symptoms regarding the various body systems.
Musculoskeletal System
Subcategories
Complicated
Review of Systems (ROS)
43. Upper jaw bone
Accident
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Flat bones
Maxilla
44. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Zygoma
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
45. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages
Humerus
Liability insurance
Hairline
New patient
46. The moon like white area at the base of the nail.
Suicide Attempt
There are two types of sweat glands
Review of Systems (ROS)
lunula
47. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Advance Beneficiary Notice
Clean claim
encounter form
Benign
48. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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49. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Neoplasm Table
Fissure
Flat bones
50. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Health Insurance Portability and Accountability Act (HIPAA)
Malignant
Categories
Assault