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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. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Coordination of Benefits (COB)
Add-on codes
Employer Identification Number (EIN)
-32 - Mandated Services
2. open sore on the skin or mucous
Fissure
Ulcermembranes
Peer Review Organization (PRO)
sebaceous(oil) glands and the suddoriferous (sweat) glands
3. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Physician
Paper Claim
Rib Cage
Lipocyte
4. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Health Care Financing Administration Common Procedure Coding System
National Correct Coding Initiative (NCCI)
Liability insurance
Greenstick
5. 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
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Subcategories
Liability insurance
HCPCS Level I codes
6. 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
Temporal Bone
There are three layers to the skin
Reasons for Documentation
Coinsurance
7. anterior to the temporal bones.
Sphenoid Bones
The Current Procedural Terminology (CPT)
Chief complaint (CC)
Section 3 Index to External Causes of Injury (E codes)
8. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Long bones
-90 - Reference (Outside) Laboratory
Fee-for-Service
Parietal Bones
9. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
-90 - Reference (Outside) Laboratory
Health Care Financing Administration Common Procedure Coding System
Coordination of Benefits (COB)
Add-on codes
10. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Medically needy
Malignant
-90 - Reference (Outside) Laboratory
Group Insurance
11. The fractured area of bone collapses on itself.
Compression fracture
Undetermined
Indemnity Insurance
MEDICARE Part A
12.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Group Insurance
Fiscal Intermediary
Gender rule
13. The lower anterior part of the bone
Alphabetic Index (Volume 2)
Established Patient
Pubic bone
-99 - Multiple Modifiers
14. make up part of the roof of the mouth
Health Insurance Portability and Accountability Act (HIPAA)
Palatine bones
The Integumentary System
History of present illness (HPI)
15. The cuticle at the lower part of the nail and this is sometimes referred to as the
Categories
Occipital Bone
There are two types of sweat glands
eponychium
16. 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.
National Correct Coding Initiative (NCCI)
Fissure
Outpatient
Dirty claim
17. Deficient in pigment (melanin)
Unlisted Procedures Procedures
Lacrimal bones
Albino
The Current Procedural Terminology (CPT)
18. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Fiscal Intermediary
Paper Claim
Fee Schedule
Colles
19. Number assigned by the insurance company to a physician who renders services to patients.
State License Number
Provider Identification Number (PIN)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Limited ROM
20. the bone is broken and the ends are driven into each other.
Established patient
Impacted
Medigap (Medicare Supplemental Insurance)
Health Maintenance Organization (HMO)
21. 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
Medicare Claim Status
Advance Beneficiary Notice
Civil Monetary Penalties Law (CMPL)
Capitated Rates
22. 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
Salter-Harris
Coinsurance
Retention of Medical Records
-51 - Multiple Procedures
23. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Carpals
Inferior nasal conchae
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Wheal
24. 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
Neoplasm Table
Unlisted Procedures Procedures
The St. Anthony Relative Value for Physicians (RVP)
Compression fracture
25. Represents a new procedure or service code added since the previous edition of the manual.
stand-alone codes
Eligibility
Frontal Bone
bullet (a
26. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
The Good Samaritan Act
No ROM
Coding
Blue Cross/Blue Shield Plans
27. Pre-determined set of benefits covered under one set annual fee.
Accept assignment
Neoplasm Table
Pre-paid Health Plan
False ribs
28. the bone is broken and the ends are driven into each other.
Unauthorized benefit
False ribs
Impacted
Patient Confidentiality
29. Groove or crack like sore
False Claims Act (FCA)
Fissure
Melanin
TRICARE PLANS
30. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Lipocyte
true ribs
Provider Identification Number (PIN)
Add-on codes
31. 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
Compression fracture
MEDICAID COVERAGE
Fraud
CPT SECTIONS.
32. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Hypertension Table
Chief complaint (CC)
Frontal Bone
33. Is an electronic or paper-based report of payment sent by the payer to the provider.
Unspecified (hypertension)
Remittance Advice
Ischium
phalanges (phalanx.s)
34. A fracture of the epiphyseal plate in children.
Social Security Number
true ribs
Provider Identification Number (PIN)
Salter-Harris
35. The physician must obtain this number in order to practice within a state.
State License Number
Fee Schedule
Medicare
Peer Review Organization (PRO)
36. 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
Category I Codes CPT
stand-alone codes
Undetermined
Categories
37. forms the two lower sides of the cranium.
Malignant
Performing Provider Identification Number (PPIN)
TRICARE PLANS
Temporal Bone
38. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
Preferred Provider Organization (PPO)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
itemized statement
Commercial Carriers
39. Benign growth extending from the surface of the mucous membrane
Impetigo
Employer Identification Number (EIN)
Polyp
Sections
40. 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
Lacrimal bones
Multigravida
Location Methods
Health Maintenance Organization (HMO)
41. 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.
Comminuted fracture
Medigap (Medicare Supplemental Insurance)
CPT SECTIONS.
Performing Provider Identification Number (PPIN)
42. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Accept assignment
Pre-certification
Category III Codes CPT
Gender rule
43. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Pre-certification
Carcinoma (Ca) in situ
History of present illness (HPI)
Exclusions and Limitations
44. 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.
Qualified diagnosis
Benign
Medicaid
Chief complaint (CC)
45. Law passed by the federal government to prosecute cases of Medicaid fraud.
Health Insurance Portability and Accountability Act (HIPAA)
Civil Monetary Penalties Law (CMPL)
History of present illness (HPI)
Categorically needy -MEDICAID
46. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
Employer Liability
Accept assignment
Group Provider Number
Sebaceous glands
47. 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.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Peer Review Organization (PRO)
Sebaceous glands
MEDICARE Part A
48. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
HCPCS Level I codes
Benign
Employer Identification Number (EIN)
Sections
49. The poisoning was self-inflicted.
Civil Monetary Penalties Law (CMPL)
Maxilla
Physician
Suicide Attempt
50. 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
Birthday rule
There are two types of sweat glands
Retention of Medical Records