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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. numbers 8-10 - are attached to the sternum by cartilage
ulna
False ribs
Abuse
Remittance Advice
2. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
Capitated Rates
Medically needy
Evaluation and Management Review
Workers Compensation
3. The bone is broken and pierces an internal organ
essential modifiers
Complicated
Benign
Participating physician
4. 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
Pathologic
nonessential modifiers
eponychium
Blue Cross/Blue Shield Plans
5. Pre-determined set of benefits covered under one set annual fee.
upper appendicular skeleton
Lipocyte
Fee Schedule
Pre-paid Health Plan
6. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Hairline
Group Provider Number
Polyp
Category II Codes CPT
7. is defined as one who has not received any medical services within the last three years.
New Patient
History of present illness (HPI)
Inpatient
-51 - Multiple Procedures
8. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
Category I Codes CPT
Employee Liability
Macule
The Integumentary System
9. Forms the anterior part of the skull and the forehead
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Frontal Bone
Group Provider Number
The Current Procedural Terminology (CPT)
10. 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
Chief complaint
Non-covered benefit
Relative Value Payment Schedules Method
-99 - Multiple Modifiers
11. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Complicated
Unspecified nature
encounter form
Contracted Rates with MCOs
12. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.
co-payment
Retention of Medical Records
ulna
Carcinoma (Ca) in situ
13. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Subcategories
The Integumentary System
Keratin
The St. Anthony Relative Value for Physicians (RVP)
14. most synarthroses are immovable joints held together by fibrous tissue.
Dirty claim
Two triangular symbols (a
No ROM
The Universal Claim Form
15. 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
Impacted
MEDICARE Part C
Category I Codes CPT
Remittance Advice
16. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Employer Liability
Coinsurance
Sebaceous glands
Impetigo
17. 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
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Outpatient
Subcategories
Location Methods
18. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Invalid claim
Primary malignancy
Evaluation and Management Review
Wheal
19. 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.
nonessential modifiers
Medicaid
Chief complaint
New patient
20. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
Exclusions and Limitations
Medically needy
Paper Claim
Fraud
21. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.
Impetigo
Retention of Medical Records
Preferred Provider plan
Maxilla
22. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Tabular List (Volume 1)...
Multigravida
-26 - Professional Component
Advance Beneficiary Notice
23. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Chief complaint
Deductible
TRICARE
Greenstick
24. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Unauthorized benefit
Deductible
Chief complaint (CC)
nonessential modifiers
25. 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.
New patient
Employer Liability
Pre-determination
Comminuted fracture
26. 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.
TRICARE PLANS
New patient
Malignant
Collagen
27. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
HCPCS Level I codes
Peer Review Organization (PRO)
Medical Records
stand-alone codes
28. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
The Current Procedural Terminology (CPT)
Category III Codes CPT
MEDICARE Part B
MEDICARE Part A
29. Further classified as to primary - secondary - or carcinoma in situ.
Physician
Non-covered benefit
Malignant
Physician
30. Cheekbone
Medical Records
Fissure
Zygoma
There are three layers to the skin
31. 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
Frontal Bone
Spinal/Vertebral Column
Melanin
Outpatient
32. Are composed of three-digit codes representing a single disease or condition.
Mutually Exclusive Edits
Categories
Fiscal Intermediary
Medical necessity
33. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
There are three layers to the skin
Clean claim
encounter form
Established Patient
34. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
Group practice
Add-on codes
-99 - Multiple Modifiers
The Integumentary System
35. 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
Fee Schedule
Health Maintenance Organization (HMO)
eponychium
Personal Insurance
36. is defined as one who has not received any medical services within the last three years.
Unspecified (hypertension)
New Patient
Suicide Attempt
Long bones
37. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Performing Provider Identification Number (PPIN)
Physician
Unique Provider Identification Number (UPIN)
Preferred Provider plan
38. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features
Pathologic
Medicare
Reasons for Documentation
Electronic Claim
39. 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.
Medicaid
Multigravida
Clean claim
Hairline
40. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
Melanin
Ischium
-32 - Mandated Services
Fee Schedule
41. 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
Commercial Carriers
Review of Systems (ROS)
Clearinghouse
Participating physician
42. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
MEDICARE Part B
Subcategories
Personal Insurance
Parietal Bones
43. Poisoning cannot be determined whether intentional or accidental.
Pubic bone
upper appendicular skeleton
Undetermined
The Universal Claim Form
44. This is a set of information the physician gathers from the patient regarding the following:
History
Limited ROM
Blue Cross/Blue Shield Plans
Gangrene
45. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Abuse
Birthday rule
HCPCS Level I codes
Temporal Bone
46. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Ischium
Review of Systems (ROS)
There are two types of sweat glands
Deductible
47. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin
Assault
Paper Claim
The Current Procedural Terminology (CPT)
-51 - Multiple Procedures
48. 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.
Mandible
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Workers Compensation
Gender rule
49. Is made up of the shoulder - collar - pelvic and arms and legs
appendicular skeleton .
Complicated
-50 - Bilateral Procedure
Medigap (Medicare Supplemental Insurance)
50. 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.
Section 3 Index to External Causes of Injury (E codes)
Undetermined
Health Care Financing Administration Common Procedure Coding System
Group Provider Number