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Test your basic knowledge |
Medical Billing And Coding Vocab
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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. 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
Medicare
Coinsurance
MEDICARE Part D
Electronic Claim
2. 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.
Clean claim
Add-on codes
Accident
Location Methods
3. Law passed by the federal government to prosecute cases of Medicaid fraud.
stand-alone codes
Parietal Bones
Civil Monetary Penalties Law (CMPL)
The St. Anthony Relative Value for Physicians (RVP)
4. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
TRICARE
Collagen
Unspecified nature
HCPCS Level I codes
5. Is the lateral lower arm bone (in line with the thumb).
itemized statement
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Reasons for Documentation
Radius
6. 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.
Evaluation and Management Review
Retention of Medical Records
History
Patient Confidentiality
7. numbers 8-10 - are attached to the sternum by cartilage
False ribs
Wheal
-51 - Multiple Procedures
Benign (hypertension)
8. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Category I Codes CPT
Fiscal Intermediary
Peer Review Organization (PRO)
TRICARE PLANS
9. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
TRICARE PLANS
Alphabetic Index (Volume 2)
Nodule
10. 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.
Paper Claim
Pelvis
Contracted Rates with MCOs
Preferred Provider plan
11. 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.
Humerus
MEDICARE Part C
Colles
axial skeleton
12. Numbers 1-7 - attach directly to the sternum in the front of the body.
Fissure
true ribs
MEDICARE Part C
Categorically needy -MEDICAID
13. Forms the anterior part of the skull and the forehead
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Reasons for Documentation
Group practice
Frontal Bone
14. Number assigned by the insurance company to a physician who renders services to patients.
Macule
TRICARE
Health Care Financing Administration Common Procedure Coding System
Provider Identification Number (PIN)
15. Typically not used on the claim form unless the provider does not have an EIN.
Social Security Number
bullet (a
Indemnity Insurance
Accident
16. 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:
Vomer
Contracted Rates with MCOs
A plus sign (+)
Hypertension Table
17. Most billing-related cases are based on HIPAA and False Claims Act.
Alopecia
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Compliance Regulations
-50 - Bilateral Procedure
18. 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
TRICARE PLANS
Neoplasm Table
Lipocyte
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
19. 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)
Multigravida
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Spinal/Vertebral Column
20. 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
Commercial Carriers
Capitated Rates
Evaluation and Management Review
MEDICARE Part B
21. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Long bones
Palatine bones
Macule
Civil Monetary Penalties Law (CMPL)
22. 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....
Nonparticipating physician
The Current Procedural Terminology (CPT)
Gender rule
The St. Anthony Relative Value for Physicians (RVP)
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
Blue Cross/Blue Shield Plans
Rib Cage
The St. Anthony Relative Value for Physicians (RVP)
Group Insurance
24. major skin pigment
Location Methods
Melanin
Evaluation and Management Review
Outpatient
25. 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
Chief complaint (CC)
Ischium
Unlisted Procedures Procedures
Pre-determination
26. Most billing-related cases are based on HIPAA and False Claims Act.
There are three layers to the skin
upper appendicular skeleton
Compliance Regulations
Impacted
27. Deficient in pigment (melanin)
Impetigo
Ischium
Albino
Section 3 Index to External Causes of Injury (E codes)
28. requires investigation and needs further clarification.
Rejected claim
Benign
History
Past - family and social history (PFSH)
29. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Pre-certification
Accept assignment
Melanin
-90 - Reference (Outside) Laboratory
30. 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
Surgical Package
Rib Cage
Abuse
Disability insurance
31. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Abuse
Alopecia
Malignant
Disability insurance
32. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
The Current Procedural Terminology (CPT)
Compliance Regulations
Hairline
33. is defined as one who has not received any medical services within the last three years.
Hairline
Medicaid
New Patient
Short bones
34. 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
Primary malignancy
Add-on codes
Disability insurance
-50 - Bilateral Procedure
35. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Provider Identification Number (PIN)
MEDICARE Part A
Deductible
appendicular skeleton .
36. 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
MEDICARE Part D
Capitated Rates
Add-on codes
Section 3 Index to External Causes of Injury (E codes)
37. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
Comminuted fracture
State License Number
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
itemized statement
38. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Macule
Pathologic
Medicare
Comminuted fracture
39. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
-50 - Bilateral Procedure
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Long bones
Contracted Rates with MCOs
40. anterior to the temporal bones.
Sphenoid Bones
Salter-Harris
Radius
Zygoma
41. 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.'
Medical necessity
Participating physician
Peer Review Organization (PRO)
HCPCS Level I codes
42. 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
Nonparticipating physician
Performing Provider Identification Number (PPIN)
Preferred Provider Organization (PPO)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
43. 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.
Dirty claim
Participating physician
Temporal Bone
Review of Systems (ROS)
44. Number assigned to the physician by Medicare program.
Humerus
Section 3 Index to External Causes of Injury (E codes)
Unique Provider Identification Number (UPIN)
Coding
45. 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
axial skeleton
Inpatient
Musculoskeletal System
MEDICARE Part B
46. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Categorically needy -MEDICAID
Medicare Claim Status
Unique Provider Identification Number (UPIN)
Palatine bones
47. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Employer Identification Number (EIN)
Melanin
Section 3 Index to External Causes of Injury (E codes)
Mandible
48. Are composed of three-digit codes representing a single disease or condition.
CPT SECTIONS.
Medical Records
Categories
Maxilla
49. A fracture of the epiphyseal plate in children.
Salter-Harris
encounter form
upper appendicular skeleton
Category II Codes CPT
50. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
Compression fracture
Preferred Provider Organization (PPO)
The Universal Claim Form
TRICARE