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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. Is an electronic or paper-based report of payment sent by the payer to the provider.
Greenstick
Remittance Advice
Hypertension Table
Fiscal Intermediary
2. Deficient in pigment (melanin)
Participating physician
Melanin
Albino
Two triangular symbols (a
3. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Alphabetic Index (Volume 2)
Location Methods
-32 - Mandated Services
Point-of-Service plan (POS)
4. 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.
MEDICAID COVERAGE
Medical necessity
Liability insurance
Advance Beneficiary Notice
5. 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.
Workers Compensation
Flat bones
itemized statement
circle with a line through it)
6. forms the roof of the nasal cavity.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Comminuted fracture
Ethmoid Bone
Flat bones
7. This is not specified as benign or malignant in the diagnosis or medical record.
Colles
Fee Schedule
Unspecified (hypertension)
Sub classification
8. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
A plus sign (+)
Greenstick
Peer Review Organization (PRO)
Reasons for Documentation
9. 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
Paper Claim
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
The Universal Claim Form
Fiscal Intermediary
10. Small collection of clear fluid;blister
Vesicle
Limited ROM
Fee Schedule
essential modifiers
11. Upper jaw bone
Temporal Bone
TRICARE
Maxilla
National Correct Coding Initiative (NCCI)
12. Number assigned to the physician by Medicare program.
Coinsurance
Unique Provider Identification Number (UPIN)
Deductible
premium
13. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Established Patient
Birthday rule
Gangrene
-26 - Professional Component
14. 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
Patient Confidentiality
MEDICARE Part A
Tabular List (Volume 1)...
essential modifiers
15. 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
Sebaceous glands
Ischium
Health Care Financing Administration Common Procedure Coding System
Gender rule
16. 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.
Gangrene
Group practice
Eligibility
National Correct Coding Initiative (NCCI)
17. uncertain whether benign or malignant; borderline malignancy
The Current Procedural Terminology (CPT)
The Universal Claim Form
Uncertain behavior
A plus sign (+)
18. 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.
Fissure
-32 - Mandated Services
Albino
Category II Codes CPT
19. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
MEDICAID COVERAGE
Invalid claim
Blue Cross/Blue Shield Plans
20. This is the inventory of the constitutional symptoms regarding the various body systems.
Collagen
Review of Systems (ROS)
Medigap (Medicare Supplemental Insurance)
Malignant
21. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
False ribs
Pre-authorization
encounter form
Malignant
22. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Eligibility
Inferior nasal conchae
Occipital Bone
MEDICARE Part A
23. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Complicated
Secondary malignancy
The Good Samaritan Act
Peer Review Organization (PRO)
24. 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.
Sesamoid bones
Group Provider Number
National Correct Coding Initiative (NCCI)
Review of Systems (ROS)
25. The main term in the index may by followed by terms within parenthesis.
Uncertain behavior
Unique Provider Identification Number (UPIN)
sebaceous(oil) glands and the suddoriferous (sweat) glands
Alphabetic Index (Volume 2)
26. 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
Health Care Financing Administration Common Procedure Coding System
Inferior nasal conchae
TRICARE
27. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
There are two types of sweat glands
Birthday rule
lunula
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
28. 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
nonessential modifiers
Category I Codes CPT
Full ROM
Workers Compensation
29. The bone is broken and pierces an internal organ
Alphabetic Index (Volume 2)
Complicated
Review of Systems (ROS)
Indemnity Insurance
30. 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.
The St. Anthony Relative Value for Physicians (RVP)
Civil Monetary Penalties Law (CMPL)
Coinsurance
Modifiers
31. 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.
Pubic bone
Modifiers
Established Patient
Neoplasm Table
32. Upper jaw bone
co-payment
MEDICARE Part A
New patient
Maxilla
33. Absence of hair from areas where it normally grows
Accident
Alopecia
co-payment
Alphabetic Index (Volume 2)
34. 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.
Short bones
Physician
Frontal Bone
Fraud
35. Most billing-related cases are based on HIPAA and False Claims Act.
Chief complaint
CPT SECTIONS.
Compliance Regulations
Coinsurance
36. make up part of the roof of the mouth
The St. Anthony Relative Value for Physicians (RVP)
Sub classification
Pre-paid Health Plan
Palatine bones
37. 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.
Macule
Category III Codes CPT
Explanation of Benefits (EOB)
Pelvis
38. 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.
Group Provider Number
Malignant
bullet (a
HCPCS Level I codes
39. represents Exemption from the use of modifier -51
Reasons for Documentation
Malignant
circle with a line through it)
Modifiers
40. Make up part of the interior of the nose.
Employer Liability
Inferior nasal conchae
phalanges (phalanx.s)
Two triangular symbols (a
41. Is when two insurance companies work together to coordinate payment of the benefits.
Health Care Financing Administration Common Procedure Coding System
Non-covered benefit
Coordination of Benefits (COB)
Hairline
42. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Point-of-Service plan (POS)
Zygoma
Rib Cage
Preferred Provider plan
43. 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
CPT SECTIONS.
Health Maintenance Organization (HMO)
Category II Codes CPT
Health Maintenance Organization (HMO)
44. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Pre-determination
Lacrimal bones
Sebaceous glands
45. 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
Clearinghouse
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Short bones
Surgical Package
46. Poisoning cannot be determined whether intentional or accidental.
nonessential modifiers
Comminuted fracture
Modifiers
Undetermined
47. The reason the patient came to see the physician.
Clean claim
sprain
Chief complaint (CC)
Collagen
48. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Benign
co-payment
Spinal/Vertebral Column
49. 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.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
axial skeleton
Medicaid
Fissure
50. Is one who has no contract with the health insurance plan.
Collagen
Nonparticipating physician
Hypertension Table
Disability insurance