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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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study here
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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 the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.
-32 - Mandated Services
Unauthorized benefit
Preferred Provider plan
Impacted
2. most synarthroses are immovable joints held together by fibrous tissue.
A plus sign (+)
No ROM
Fraud
Invalid claim
3. 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.
The Good Samaritan Act
-99 - Multiple Modifiers
Review of Systems (ROS)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
4. 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
Subcategories
Sebaceous glands
Exclusions and Limitations
Flat bones
5. 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
Malignant
Fiscal Intermediary
Eligibility
6. 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
encounter form
Accident
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Surgical Package
7. The fractured area of bone collapses on itself.
Compression fracture
Rejected claim
Lipocyte
Advance Beneficiary Notice
8. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
MEDICARE Part B
Performing Provider Identification Number (PPIN)
Impetigo
MEDICAID COVERAGE
9. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
-99 - Multiple Modifiers
Vesicle
Civil Monetary Penalties Law (CMPL)
Health Care Financing Administration Common Procedure Coding System
10. 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
Salter-Harris
Alopecia
Clearinghouse
11. The cuticle at the lower part of the nail and this is sometimes referred to as the
eponychium
Group Provider Number
Keratin
New patient
12. Forms the sides of the cranium
Humerus
Parietal Bones
Liability insurance
Short bones
13. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Wheal
Albino
The St. Anthony Relative Value for Physicians (RVP)
14. poisoning was inflicted by another person with intent to kill or injure
Undetermined
Pelvis
Assault
axial skeleton
15. solid - round or oval elevated lesion more than 1 cm in diameter
Unique Provider Identification Number (UPIN)
There are three layers to the skin
CPT SECTIONS.
Nodule
16. Superior and widest bone
Pelvis
Compliance Regulations
There are three layers to the skin
Limited ROM
17. 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..
Musculoskeletal System
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Assault
The Integumentary System
18. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
sprain
Employee Liability
Tabular List (Volume 1)...
Birthday rule
19. 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.
Remittance Advice
Lacrimal bones
triangle (a
appendicular skeleton .
20. Groove or crack like sore
Medically needy
Eligibility
Clean claim
Fissure
21. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Mandible
Macule
bullet (a
Deductible
22. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
Preferred Provider Organization (PPO)
Health practitioner
Civil Monetary Penalties Law (CMPL)
Contracted Rates with MCOs
23. represents Exemption from the use of modifier -51
Rejected claim
Fee-for-Service
Electronic Claim
circle with a line through it)
24. 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.
upper appendicular skeleton
HCPCS Level II codes (National Codes)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
co-payment
25. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Indemnity Insurance
Paper Claim
Group practice
Unauthorized benefit
26. A pregnant woman who has had at least one previous pregnancy.
Categories
Multigravida
Fee Schedule
Modifiers
27. major skin pigment
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Melanin
Limited ROM
Section 3 Index to External Causes of Injury (E codes)
28. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Lacrimal bones
A plus sign (+)
Relative Value Payment Schedules Method
Hairline
29. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Accept assignment
The Patient Care Partnership (Patient's Bill of Rights)
Carpals
Full ROM
30. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Alphabetic Index (Volume 2)
Fee-for-Service
Sub classification
Health Maintenance Organization (HMO)
31. the bone is broken and the ends are driven into each other.
Impacted
nonessential modifiers
Patient Confidentiality
-26 - Professional Component
32. Is the upper arm bone.
The St. Anthony Relative Value for Physicians (RVP)
Birthday rule
Humerus
Non-covered benefit
33. Mild or controlled hypertension and no damage to the vascular system or organs.
Frontal Bone
Benign (hypertension)
Point-of-Service plan (POS)
axial skeleton
34. is a traumatic injury to a joint involving the soft tissue.
MEDICARE Part B
Lipocyte
sprain
Occipital Bone
35. 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
Medigap (Medicare Supplemental Insurance)
-51 - Multiple Procedures
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Humerus
36. open sore on the skin or mucous
Pre-determination
Palatine bones
Gangrene
Ulcermembranes
37. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Occipital Bone
Employer Liability
Pre-paid Health Plan
38. 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
Past - family and social history (PFSH)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Vesicle
39. A fat cell
Rejected claim
Reasons for Documentation
Undetermined
Lipocyte
40. 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.
Medicare Claim Status
Rejected claim
Modifiers
axial skeleton
41. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Categories
Nodule
eponychium
Long bones
42. 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.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Colles
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Compression fracture
43. 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
Colles
Greenstick
Evaluation and Management Review
44. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Neoplasm Table
Pathologic
Flat bones
Greenstick
45. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
Evaluation and Management Review
Deductible
Limited ROM
Multigravida
46. Poisoning cannot be determined whether intentional or accidental.
Gangrene
CPT SECTIONS.
Undetermined
Past - family and social history (PFSH)
47. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Keratin
TRICARE
State License Number
Established patient
48. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
itemized statement
Abuse
Disability insurance
Accept assignment
49. Cheekbone
Vesicle
Employer Identification Number (EIN)
Participating physician
Zygoma
50. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Fee-for-Service
Limited ROM
eponychium
Category II Codes CPT