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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. 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.
Hypertension Table
Wheal
Pre-determination
Medical necessity
2. 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
Accident
Exclusions and Limitations
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Group Insurance
3. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
-26 - Professional Component
-90 - Reference (Outside) Laboratory
Group Provider Number
Medicare Claim Status
4. Forms the sides of the cranium
Parietal Bones
Gender rule
Eligibility
Pelvis
5. 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
Location Methods
Pelvis
There are three layers to the skin
true ribs
6. Indicates add-on codes
Qualified diagnosis
A plus sign (+)
Frontal Bone
Radius
7. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Radius
Medicare
Subcategories
Malignant
8. Produce secretions that allow the body to be moisturized or cooled.
sebaceous(oil) glands and the suddoriferous (sweat) glands
History of present illness (HPI)
Medical Records
Personal Insurance
9. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
Ulcermembranes
The Universal Claim Form
Employee Liability
Established Patient
10. 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)...
The Current Procedural Terminology (CPT)
Nonparticipating physician
axial skeleton
11. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Advance Beneficiary Notice
Rejected claim
Compression fracture
Participating physician
12. Number assigned by the insurance company to a physician who renders services to patients.
Point-of-Service plan (POS)
Provider Identification Number (PIN)
Health Care Financing Administration Common Procedure Coding System
Chapters
13. Is one who has no contract with the health insurance plan.
Capitated Rates
Nonparticipating physician
phalanges (phalanx.s)
Flat bones
14. Most billing-related cases are based on HIPAA and False Claims Act.
Colles
Comminuted fracture
Compliance Regulations
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
15. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Chief complaint
Full ROM
Undetermined
Fiscal Intermediary
16. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Salter-Harris
Fee Schedule
Advance Beneficiary Notice
upper appendicular skeleton
17. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Medical Records
The Good Samaritan Act
Medigap (Medicare Supplemental Insurance)
18. 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
-99 - Multiple Modifiers
Wheal
Commercial Carriers
circle with a line through it)
19. The poisoning was self-inflicted.
Pubic bone
sebaceous(oil) glands and the suddoriferous (sweat) glands
phalanges (phalanx.s)
Suicide Attempt
20. 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
Accident
Keratin
Pre-authorization
Deductible
21. 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
Hairline
Fee-for-Service
Collagen
ligaments
22. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Temporal Bone
Pre-certification
Secondary malignancy
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
23. forms the two lower sides of the cranium.
sprain
Civil Monetary Penalties Law (CMPL)
Temporal Bone
-99 - Multiple Modifiers
24. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Unspecified nature
Hypertension Table
Dirty claim
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
25. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Sections
Fraud
Health Insurance Portability and Accountability Act (HIPAA)
Vomer
26. 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
HCPCS Level II codes (National Codes)
MEDICARE Part D
Medical Records
Full ROM
27. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Keratin
Flat bones
axial skeleton
Pelvis
28. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Provider Identification Number (PIN)
Pathologic
Melanin
Peer Review Organization (PRO)
29. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Peer Review Organization (PRO)
Limited ROM
Contracted Rates with MCOs
Personal Insurance
30. solid - round or oval elevated lesion more than 1 cm in diameter
Category III Codes CPT
Pelvis
Salter-Harris
Nodule
31. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
Unlisted Procedures Procedures
sprain
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Ulcermembranes
32. 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.
-32 - Mandated Services
Undetermined
Compression fracture
Deductible
33. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Primary malignancy
Limited ROM
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
34. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
Compression fracture
Macule
-50 - Bilateral Procedure
35. Is an electronic or paper-based report of payment sent by the payer to the provider.
Parietal Bones
Remittance Advice
Maxilla
Employer Identification Number (EIN)
36. poisoning was inflicted by another person with intent to kill or injure
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
State License Number
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Assault
37. 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
-50 - Bilateral Procedure
Clearinghouse
Tabular List (Volume 1)...
Musculoskeletal System
38. 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.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
triangle (a
Reasons for Documentation
Sebaceous glands
39. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Coding
Provider Identification Number (PIN)
State License Number
encounter form
40. This is a set of information the physician gathers from the patient regarding the following:
Contracted Rates with MCOs
Gender rule
History
CPT SECTIONS.
41. 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
axial skeleton
Subcategories
History
Neoplasm Table
42. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
-51 - Multiple Procedures
Preferred Provider Organization (PPO)
Zygoma
Rib Cage
43. 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
Consultation
Limited ROM
Categories
-51 - Multiple Procedures
44. 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
Accident
Hypertension Table
Parietal Bones
Health Maintenance Organization (HMO)
45. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Medicare
Paper Claim
MEDICARE Part C
Rib Cage
46. represents Exemption from the use of modifier -51
Spinal/Vertebral Column
circle with a line through it)
Vesicle
Contracted Rates with MCOs
47. 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)
Undetermined
Zygoma
Pathologic
48. This is not specified as benign or malignant in the diagnosis or medical record.
Clean claim
Unspecified (hypertension)
Pathologic
Humerus
49. 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
eponychium
sprain
Hairline
Fee Schedule
50. 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
Vesicle
Mandible
stand-alone codes
Blue Cross/Blue Shield Plans