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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. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Birthday rule
axial skeleton
The Universal Claim Form
Commercial Carriers
2. 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.
Medically needy
Non-covered benefit
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Unlisted Procedures Procedures
3. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
Keratin
Two triangular symbols (a
Pre-authorization
CPT SECTIONS.
4. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Neoplasm Table
Unspecified (hypertension)
-50 - Bilateral Procedure
There are three layers to the skin
5. 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
Categorically needy -MEDICAID
Patient Confidentiality
Coding
Category I Codes CPT
6. 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....
Employer Identification Number (EIN)
Secondary malignancy
Gangrene
The St. Anthony Relative Value for Physicians (RVP)
7. 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
Coordination of Benefits (COB)
Group Provider Number
Review of Systems (ROS)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
8. is a traumatic injury to a joint involving the soft tissue.
Gender rule
Inpatient
Compliance Regulations
sprain
9. death of tissue associated with loss of blood supply
Gangrene
Review of Systems (ROS)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Invalid claim
10. The moon like white area at the base of the nail.
New patient
lunula
Chapters
Complicated
11. 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
Impacted
eponychium
Polyp
12. '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
Malignant
Multigravida
Employee Liability
History
13. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
essential modifiers
Patient Confidentiality
Medical necessity
Social Security Number
14. 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
The Good Samaritan Act
Consultation
appendicular skeleton .
15. 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.
Vesicle
ulna
triangle (a
Chapters
16. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
true ribs
Impetigo
Deductible
Pre-authorization
17. The moon like white area at the base of the nail.
False ribs
Inpatient
lunula
New patient
18. 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
Past - family and social history (PFSH)
Employer Liability
Short bones
Civil Monetary Penalties Law (CMPL)
19. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
Full ROM
Advance Beneficiary Notice
MEDICARE Part B
20. 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.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Modifiers
Chief complaint (CC)
Unauthorized benefit
21. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Medically needy
Carcinoma (Ca) in situ
Peer Review Organization (PRO)
22. 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
Nonparticipating physician
-51 - Multiple Procedures
Fraud
Evaluation and Management Review
23. Is the qualifying factor or factors that must be met before a patient receives benefits.
Sections
Commercial Carriers
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Eligibility
24. Numbers 1-7 - attach directly to the sternum in the front of the body.
true ribs
sebaceous(oil) glands and the suddoriferous (sweat) glands
Clearinghouse
premium
25. 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).
Sections
Coinsurance
Albino
Exclusions and Limitations
26. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
Deductible
-99 - Multiple Modifiers
History of present illness (HPI)
Sub classification
27. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Collagen
circle with a line through it)
There are three layers to the skin
28. Poisoning cannot be determined whether intentional or accidental.
Undetermined
HCPCS Level II codes (National Codes)
lunula
Chapters
29. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Long bones
Medigap (Medicare Supplemental Insurance)
Exclusions and Limitations
Unspecified (hypertension)
30. 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.
Suicide Attempt
National Correct Coding Initiative (NCCI)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Tabular List (Volume 1)...
31. 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
Category II Codes CPT
Medically needy
Categorically needy -MEDICAID
Hairline
32. A fat cell
Lipocyte
There are two types of sweat glands
Spinal/Vertebral Column
Preferred Provider plan
33. 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
Personal Insurance
No ROM
Flat bones
34. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
ligaments
Melanin
Undetermined
There are two types of sweat glands
35. 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
Liability insurance
Chief complaint (CC)
-51 - Multiple Procedures
MEDICARE Part C
36. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Capitated Rates
MEDICARE Part C
Hairline
Categories
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)
Sub classification
Long bones
Wheal
co-payment
38. forms the two lower sides of the cranium.
Relative Value Payment Schedules Method
Temporal Bone
Rejected claim
Medical Records
39. 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
The Patient Care Partnership (Patient's Bill of Rights)
Carcinoma (Ca) in situ
Preferred Provider Organization (PPO)
Gangrene
40. 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
stand-alone codes
The Integumentary System
Spinal/Vertebral Column
Palatine bones
41. 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
MEDICARE Part B
Accident
Melanin
Sebaceous glands
42. 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
MEDICAID COVERAGE
Pre-paid Health Plan
Impetigo
MEDICARE Part D
43. Benign growth extending from the surface of the mucous membrane
Polyp
CPT SECTIONS.
Tabular List (Volume 1)...
Keratin
44. A fracture of the epiphyseal plate in children.
circle with a line through it)
Pre-authorization
Chief complaint
Salter-Harris
45. 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....
Social Security Number
Secondary malignancy
Established patient
Musculoskeletal System
46. 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)
Invalid claim
Group Insurance
itemized statement
47. 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
Employer Liability
Health practitioner
Sub classification
Group Provider Number
48. poisoning was inflicted by another person with intent to kill or injure
Impacted
Pre-paid Health Plan
Assault
Chief complaint (CC)
49. 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
Fee Schedule
Explanation of Benefits (EOB)
Paper Claim
50. Is the upper arm bone.
Liability insurance
New Patient
Rib Cage
Humerus