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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. - 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
Category II Codes CPT
Provider Identification Number (PIN)
Medigap (Medicare Supplemental Insurance)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
2. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Macule
History of present illness (HPI)
Collagen
Rib Cage
3. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
Maxilla
Impacted
Zygoma
MEDICARE Part D
4. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Add-on codes
Parietal Bones
essential modifiers
Ethmoid Bone
5. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
New Patient
Fiscal Intermediary
Malignant
Gangrene
6. is a traumatic injury to a joint involving the soft tissue.
Coding
sprain
False ribs
Exclusions and Limitations
7. Forms the anterior part of the skull and the forehead
Maxilla
Health Care Financing Administration Common Procedure Coding System
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Frontal Bone
8. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Limited ROM
Coding
-51 - Multiple Procedures
Occipital Bone
9. poisoning was inflicted by another person with intent to kill or injure
Employer Liability
Assault
Primary malignancy
Electronic Claim
10. 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
Medigap (Medicare Supplemental Insurance)
Neoplasm Table
Coordination of Benefits (COB)
Colles
11. 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
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Colles
Civil Monetary Penalties Law (CMPL)
Point-of-Service plan (POS)
12. Lower portion of the pelvic bone
Ischium
Sesamoid bones
Greenstick
Malignant
13. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Macule
Uncertain behavior
Unlisted Procedures Procedures
Column 1/Column 2 (previously called Comprehensive/Component) Edits
14. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
Melanin
Accident
MEDICARE Part C
Section 3 Index to External Causes of Injury (E codes)
15. 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
Categorically needy -MEDICAID
Ulcermembranes
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Disability insurance
16. Consists of the skull - rib cage - and spine
Pre-paid Health Plan
Liability insurance
axial skeleton
Disability insurance
17. 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
Employee Liability
Subcategories
upper appendicular skeleton
Ischium
18. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Group Provider Number
Chief complaint
Surgical Package
Retention of Medical Records
19. A fat cell
Carpals
Alopecia
Lipocyte
Coding
20. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
There are three layers to the skin
-26 - Professional Component
MEDICARE Part B
Chapters
21. Number assigned by the insurance company to a physician who renders services to patients.
Remittance Advice
Provider Identification Number (PIN)
Colles
Medicaid
22. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
Employer Liability
Gender rule
HCPCS Level I codes
MEDICARE Part B
23. represents Exemption from the use of modifier -51
Category III Codes CPT
Assault
Sub classification
circle with a line through it)
24. 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.
Group Insurance
Deductible
Physician
Invalid claim
25. 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
Physician
MEDICAID COVERAGE
Non-covered benefit
New patient
26. 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:
Paper Claim
Group practice
False ribs
Hypertension Table
27. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Location Methods
Social Security Number
TRICARE
28. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
Fee-for-Service
Contracted Rates with MCOs
Nodule
TRICARE PLANS
29. 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
Sub classification
Alopecia
Preferred Provider Organization (PPO)
The Integumentary System
30. 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.
The St. Anthony Relative Value for Physicians (RVP)
Section 3 Index to External Causes of Injury (E codes)
Coding
New patient
31. This modifier is used when the same procedure is performed on a mirror-image part of the body..
History of present illness (HPI)
sebaceous(oil) glands and the suddoriferous (sweat) glands
-50 - Bilateral Procedure
Frontal Bone
32. 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)
Primary malignancy
Established Patient
Ethmoid Bone
33. 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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34. Most billing-related cases are based on HIPAA and False Claims Act.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Subcategories
Dirty claim
Compliance Regulations
35. Absence of hair from areas where it normally grows
Nodule
Pre-certification
Humerus
Alopecia
36. The reason the patient came to see the physician.
Chief complaint (CC)
essential modifiers
Melanin
Unauthorized benefit
37. 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
Rejected claim
False Claims Act (FCA)
Undetermined
Electronic Claim
38. 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.
Patient Confidentiality
Clean claim
Carpals
Surgical Package
39. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Secondary malignancy
eponychium
Capitated Rates
Unique Provider Identification Number (UPIN)
40. 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
Coordination of Benefits (COB)
Inferior nasal conchae
Patient Confidentiality
Lipocyte
41. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Employee Liability
History of present illness (HPI)
Point-of-Service plan (POS)
Keratin
42. Make up part of the interior of the nose.
Malignant
MEDICARE Part B
Inferior nasal conchae
Location Methods
43. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.
Pre-determination
Health Care Financing Administration Common Procedure Coding System
Liability insurance
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
44. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
There are three layers to the skin
itemized statement
TRICARE
Limited ROM
45. 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.
Health Care Financing Administration Common Procedure Coding System
False Claims Act (FCA)
Wheal
Chapters
46. 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.
-90 - Reference (Outside) Laboratory
Review of Systems (ROS)
-26 - Professional Component
Benign (hypertension)
47. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).
Relative Value Payment Schedules Method
Spinal/Vertebral Column
Compression fracture
Sections
48. 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.
stand-alone codes
National Correct Coding Initiative (NCCI)
Category II Codes CPT
Mandible
49. Upper jaw bone
Temporal Bone
Health Maintenance Organization (HMO)
Maxilla
MEDICARE Part D
50. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Unauthorized benefit
Neoplasm Table
Eligibility
Relative Value Payment Schedules Method