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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. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Benign (hypertension)
Fee Schedule
Consultation
2. 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.
Preferred Provider plan
-32 - Mandated Services
Eligibility
New Patient
3. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Health Insurance Portability and Accountability Act (HIPAA)
Add-on codes
Suicide Attempt
bullet (a
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
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Liability insurance
Neoplasm Table
Medicaid
5. 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.
Birthday rule
Dirty claim
Coding
Contracted Rates with MCOs
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
Pre-determination
Rejected claim
The Integumentary System
A plus sign (+)
7. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
Preferred Provider Organization (PPO)
Polyp
Benign
Polyp
8. numbers 8-10 - are attached to the sternum by cartilage
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Hairline
sebaceous(oil) glands and the suddoriferous (sweat) glands
False ribs
9. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
upper appendicular skeleton
Inpatient
TRICARE
Keratin
10. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Lipocyte
There are three layers to the skin
sprain
11. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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12. Produce secretions that allow the body to be moisturized or cooled.
HCPCS Level II codes (National Codes)
sebaceous(oil) glands and the suddoriferous (sweat) glands
Secondary malignancy
Employer Liability
13. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Group practice
Spinal/Vertebral Column
Alphabetic Index (Volume 2)
Salter-Harris
14. Noninvasive - non-spreading - nonmalignant
Polyp
Benign
-99 - Multiple Modifiers
-90 - Reference (Outside) Laboratory
15. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
A plus sign (+)
-90 - Reference (Outside) Laboratory
-99 - Multiple Modifiers
16. is a traumatic injury to a joint involving the soft tissue.
sprain
Commercial Carriers
False Claims Act (FCA)
Remittance Advice
17. solid - round or oval elevated lesion more than 1 cm in diameter
Compression fracture
Health Insurance Portability and Accountability Act (HIPAA)
Nodule
Mutually Exclusive Edits
18. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Unauthorized benefit
Short bones
Paper Claim
Sebaceous glands
19. uncertain whether benign or malignant; borderline malignancy
Subcategories
MEDICARE Part A
False ribs
Uncertain behavior
20. - 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
New Patient
Modifiers
Medigap (Medicare Supplemental Insurance)
Capitated Rates
21. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
Invalid claim
There are two types of sweat glands
Preferred Provider Organization (PPO)
Albino
22. Is the lateral lower arm bone (in line with the thumb).
False Claims Act (FCA)
Lipocyte
Radius
New Patient
23. 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.
-26 - Professional Component
Carpals
False ribs
Melanin
24.
Chief complaint
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Performing Provider Identification Number (PPIN)
-99 - Multiple Modifiers
25. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Dirty claim
-32 - Mandated Services
Wheal
Sections
26. Number assigned to the physician by Medicare program.
Parietal Bones
Unique Provider Identification Number (UPIN)
Maxilla
Relative Value Payment Schedules Method
27. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Compression fracture
Commercial Carriers
Eligibility
Eligibility
28. The cuticle at the lower part of the nail and this is sometimes referred to as the
Assault
Sub classification
eponychium
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
29. 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.
Sections
Physician
Macule
Albino
30. Make up part of the interior of the nose.
Health Insurance Portability and Accountability Act (HIPAA)
Inferior nasal conchae
HCPCS Level II codes (National Codes)
Zygoma
31. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Fissure
There are two types of sweat glands
False ribs
Consultation
32. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Carpals
-50 - Bilateral Procedure
Established patient
Greenstick
33. Number assigned by the insurance company to a physician who renders services to patients.
sebaceous(oil) glands and the suddoriferous (sweat) glands
true ribs
Provider Identification Number (PIN)
nonessential modifiers
34. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Add-on codes
Sphenoid Bones
Group practice
35. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
Employee Liability
Personal Insurance
Remittance Advice
36. 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
triangle (a
Unauthorized benefit
ligaments
37. the bone is broken and the ends are driven into each other.
MEDICAID COVERAGE
appendicular skeleton .
-90 - Reference (Outside) Laboratory
Impacted
38. 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
Vomer
Undetermined
Workers Compensation
Tabular List (Volume 1)...
39. This is not specified as benign or malignant in the diagnosis or medical record.
Unspecified (hypertension)
Humerus
Multigravida
Pubic bone
40. .. lower jaw bone.
False ribs
Zygoma
Mandible
HCPCS Level II codes (National Codes)
41. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Category II Codes CPT
Review of Systems (ROS)
Benign
42. 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.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Performing Provider Identification Number (PPIN)
Undetermined
Primary malignancy
43. 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....
Unspecified nature
Health practitioner
The St. Anthony Relative Value for Physicians (RVP)
Modifiers
44. poisoning was inflicted by another person with intent to kill or injure
-50 - Bilateral Procedure
Assault
Rejected claim
Clearinghouse
45. 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
Capitated Rates
sebaceous(oil) glands and the suddoriferous (sweat) glands
Pelvis
Employer Liability
46. the bone is crushed and or shattered.
There are two types of sweat glands
Comminuted fracture
Albino
Fraud
47. Typically not used on the claim form unless the provider does not have an EIN.
axial skeleton
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
essential modifiers
Social Security Number
48. 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.
Social Security Number
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Fee Schedule
Radius
49. 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
Keratin
Civil Monetary Penalties Law (CMPL)
Unspecified (hypertension)
50. 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.
Secondary malignancy
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Physician
Suicide Attempt