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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. 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
Coordination of Benefits (COB)
Subcategories
Pubic bone
Point-of-Service plan (POS)
2. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Frontal Bone
TRICARE PLANS
Explanation of Benefits (EOB)
Provider Identification Number (PIN)
3. The fractured area of bone collapses on itself.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Compression fracture
Abuse
Keratin
4. 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
Patient Confidentiality
Neoplasm Table
Impetigo
Long bones
5. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Patient Confidentiality
Non-covered benefit
axial skeleton
Secondary malignancy
6. 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
The Patient Care Partnership (Patient's Bill of Rights)
Rib Cage
The Integumentary System
HCPCS Level II codes (National Codes)
7. 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
Commercial Carriers
Relative Value Payment Schedules Method
Electronic Claim
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
8. Number assigned by the insurance company to a physician who renders services to patients.
New Patient
Nodule
Provider Identification Number (PIN)
Hairline
9. open sore on the skin or mucous
Ulcermembranes
Indemnity Insurance
eponychium
Mandible
10. is defined as one who has not received any medical services within the last three years.
Pre-determination
Unauthorized benefit
New Patient
CPT SECTIONS.
11. This is not specified as benign or malignant in the diagnosis or medical record.
Alopecia
Unspecified (hypertension)
triangle (a
Coding
12. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Health Insurance Portability and Accountability Act (HIPAA)
Capitated Rates
Macule
Two triangular symbols (a
13. The bone is broken and pierces an internal organ
Category III Codes CPT
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Complicated
State License Number
14. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
MEDICARE Part C
Pre-determination
Tabular List (Volume 1)...
Chief complaint
15. Mild or controlled hypertension and no damage to the vascular system or organs.
MEDICARE Part A
Benign (hypertension)
Coding
Fee Schedule
16. paired bones at the corner of each eye that cradle the tear ducts.
Medicaid
Musculoskeletal System
Lacrimal bones
Tabular List (Volume 1)...
17. Superior and widest bone
Point-of-Service plan (POS)
Chapters
Inpatient
Pelvis
18. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
ulna
Relative Value Payment Schedules Method
Chief complaint
MEDICARE Part C
19. Small collection of clear fluid;blister
bullet (a
Coordination of Benefits (COB)
Gender rule
Vesicle
20. forms the two lower sides of the cranium.
Pre-determination
Mandible
Physician
Temporal Bone
21. Deficient in pigment (melanin)
Employer Identification Number (EIN)
Albino
Vesicle
stand-alone codes
22. Is when two insurance companies work together to coordinate payment of the benefits.
Modifiers
Established patient
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Coordination of Benefits (COB)
23. 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.
axial skeleton
Melanin
Lacrimal bones
24. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
sebaceous(oil) glands and the suddoriferous (sweat) glands
MEDICARE Part B
Malignant
eponychium
25. 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
Coding
Hairline
Radius
Health Maintenance Organization (HMO)
26. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)
triangle (a
Vomer
co-payment
Musculoskeletal System
27. 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.
Inpatient
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Carcinoma (Ca) in situ
History of present illness (HPI)
28. uncertain whether benign or malignant; borderline malignancy
phalanges (phalanx.s)
Uncertain behavior
Workers Compensation
-51 - Multiple Procedures
29. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Tabular List (Volume 1)...
Employer Identification Number (EIN)
Preferred Provider plan
Assault
30. Discolored - flat lesion (freckles - tattoo marks)
Macule
Past - family and social history (PFSH)
Medicare Claim Status
Electronic Claim
31. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
-99 - Multiple Modifiers
Full ROM
Unspecified nature
TRICARE
32. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:
Hypertension Table
Pelvis
Fee-for-Service
sprain
33. 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
Fraud
-26 - Professional Component
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Exclusions and Limitations
34. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Category I Codes CPT
Unspecified (hypertension)
Carcinoma (Ca) in situ
35. Are composed of three-digit codes representing a single disease or condition.
Consultation
Categories
Pre-determination
Spinal/Vertebral Column
36. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages
MEDICAID COVERAGE
co-payment
Liability insurance
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
37. 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)
Malignant
Impetigo
Health practitioner
38. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
Established Patient
MEDICARE Part D
Secondary malignancy
Fiscal Intermediary
39. 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
Flat bones
False Claims Act (FCA)
Electronic Claim
No ROM
40. male of household is primary payer
triangle (a
Albino
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Gender rule
41. Is the qualifying factor or factors that must be met before a patient receives benefits.
Medicare Claim Status
Coding
Categorically needy -MEDICAID
Eligibility
42. Lower portion of the pelvic bone
Ischium
Spinal/Vertebral Column
Column 1/Column 2 (previously called Comprehensive/Component) Edits
History of present illness (HPI)
43. 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
Medicare Claim Status
Fee-for-Service
Carpals
44. Law passed by the federal government to prosecute cases of Medicaid fraud.
Civil Monetary Penalties Law (CMPL)
False Claims Act (FCA)
Impacted
Health Insurance Portability and Accountability Act (HIPAA)
45. Number assigned to the physician by Medicare program.
Unique Provider Identification Number (UPIN)
Inpatient
ulna
axial skeleton
46. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Primary malignancy
Musculoskeletal System
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Qualified diagnosis
47. Contains complete - necessary information - but is incorrect or illogical in some way.
Category II Codes CPT
Invalid claim
Keratin
Medical necessity
48. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
The Current Procedural Terminology (CPT)
Unauthorized benefit
Group Insurance
axial skeleton
49. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
CPT SECTIONS.
Retention of Medical Records
Gangrene
Medical necessity
50. 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.
-51 - Multiple Procedures
Medicaid
Long bones
Consultation