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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.
If you are not ready to take this test, you can
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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. 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.
Coding
Birthday rule
Pre-certification
Performing Provider Identification Number (PPIN)
2. Law passed by the federal government to prosecute cases of Medicaid fraud.
Pre-certification
Disability insurance
-26 - Professional Component
Civil Monetary Penalties Law (CMPL)
3. Represent changes in the text or definition between the triangles.
Fee Schedule
Two triangular symbols (a
Relative Value Payment Schedules Method
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
4. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Sections
Keratin
encounter form
Employer Liability
5. 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
Surgical Package
Accept assignment
Coinsurance
6. 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
Medicaid
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Ischium
Past - family and social history (PFSH)
7. Further classified as to primary - secondary - or carcinoma in situ.
HCPCS Level I codes
Review of Systems (ROS)
Malignant
stand-alone codes
8. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
Disability insurance
The Current Procedural Terminology (CPT)
Employer Identification Number (EIN)
encounter form
9. 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
Inferior nasal conchae
Clearinghouse
Location Methods
essential modifiers
10. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Workers Compensation
Medicare
Medical Records
Carcinoma (Ca) in situ
11. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Benign
Vesicle
Fiscal Intermediary
Accept assignment
12. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
False Claims Act (FCA)
Pubic bone
Primary malignancy
true ribs
13. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.
HCPCS Level I codes
sebaceous(oil) glands and the suddoriferous (sweat) glands
Medicare Claim Status
Inpatient
14. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
Medigap (Medicare Supplemental Insurance)
-32 - Mandated Services
essential modifiers
Blue Cross/Blue Shield Plans
15. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Hypertension Table
Undetermined
Limited ROM
Employee Liability
16. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H
Unlisted Procedures Procedures
TRICARE
Invalid claim
Carcinoma (Ca) in situ
17. 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
Health Maintenance Organization (HMO)
Short bones
Zygoma
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
18. forms the roof of the nasal cavity.
premium
Health Care Financing Administration Common Procedure Coding System
Ethmoid Bone
phalanges (phalanx.s)
19. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
MEDICARE Part B
Lipocyte
Carcinoma (Ca) in situ
Inferior nasal conchae
20. Small collection of clear fluid;blister
Colles
MEDICARE Part C
Vesicle
Benign
21. 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.
Dirty claim
triangle (a
Performing Provider Identification Number (PPIN)
Contracted Rates with MCOs
22. 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
Inpatient
Undetermined
Established Patient
Neoplasm Table
23. 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
-32 - Mandated Services
History of present illness (HPI)
Blue Cross/Blue Shield Plans
Birthday rule
24. Is the lateral lower arm bone (in line with the thumb).
Workers Compensation
Radius
Advance Beneficiary Notice
Established Patient
25. Superior and widest bone
Short bones
Pelvis
Evaluation and Management Review
Fraud
26. 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
Category I Codes CPT
triangle (a
Fraud
Unique Provider Identification Number (UPIN)
27. uncertain whether benign or malignant; borderline malignancy
Impetigo
Limited ROM
Musculoskeletal System
Uncertain behavior
28. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
Rib Cage
Carcinoma (Ca) in situ
-26 - Professional Component
Medical Records
29. Lower portion of the pelvic bone
Salter-Harris
-99 - Multiple Modifiers
-26 - Professional Component
Ischium
30. uncertain whether benign or malignant; borderline malignancy
Employee Liability
stand-alone codes
Benign
Uncertain behavior
31. 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.
Alphabetic Index (Volume 2)
Salter-Harris
Retention of Medical Records
Pre-determination
32. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
There are three layers to the skin
Spinal/Vertebral Column
Mutually Exclusive Edits
ulna
33. 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
Full ROM
Relative Value Payment Schedules Method
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
34. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
The Integumentary System
Undetermined
Chief complaint
Employer Identification Number (EIN)
35. The reason the patient came to see the physician.
Modifiers
Chief complaint (CC)
TRICARE PLANS
Retention of Medical Records
36. This is not specified as benign or malignant in the diagnosis or medical record.
Disability insurance
Unspecified (hypertension)
There are two types of sweat glands
Sebaceous glands
37. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Group Provider Number
Coinsurance
Medically needy
Hairline
38. Discolored - flat lesion (freckles - tattoo marks)
Benign (hypertension)
appendicular skeleton .
Macule
Contracted Rates with MCOs
39. Deficient in pigment (melanin)
Uncertain behavior
Albino
New patient
appendicular skeleton .
40. 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.
Capitated Rates
Section 3 Index to External Causes of Injury (E codes)
Inferior nasal conchae
Unspecified nature
41. Represents a new procedure or service code added since the previous edition of the manual.
Coordination of Benefits (COB)
bullet (a
Clean claim
Workers Compensation
42. The lower anterior part of the bone
Collagen
Clearinghouse
Pubic bone
Health Care Financing Administration Common Procedure Coding System
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
Maxilla
Abuse
-51 - Multiple Procedures
Macule
44. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Sesamoid bones
Unlisted Procedures Procedures
There are two types of sweat glands
Employee Liability
45. 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
Ethmoid Bone
ulna
Electronic Claim
Impetigo
46. 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.
Carpals
The Patient Care Partnership (Patient's Bill of Rights)
Clean claim
Sphenoid Bones
47. 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.
Salter-Harris
National Correct Coding Initiative (NCCI)
Physician
The St. Anthony Relative Value for Physicians (RVP)
48. Contains complete - necessary information - but is incorrect or illogical in some way.
Hypertension Table
Invalid claim
Liability insurance
circle with a line through it)
49. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Group Insurance
Secondary malignancy
Sections
Section 3 Index to External Causes of Injury (E codes)
50. The moon like white area at the base of the nail.
Albino
Alphabetic Index (Volume 2)
lunula
Surgical Package