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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. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Deductible
History of present illness (HPI)
Rejected claim
National Correct Coding Initiative (NCCI)
2. forms the roof of the nasal cavity.
Performing Provider Identification Number (PPIN)
Ethmoid Bone
Sebaceous glands
phalanges (phalanx.s)
3. 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
TRICARE PLANS
-99 - Multiple Modifiers
New Patient
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
4. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
Categorically needy -MEDICAID
Sections
Non-covered benefit
Two triangular symbols (a
5. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
circle with a line through it)
Pre-determination
Clearinghouse
6. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Fissure
Employer Identification Number (EIN)
MEDICARE Part A
The St. Anthony Relative Value for Physicians (RVP)
7. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
Secondary malignancy
National Correct Coding Initiative (NCCI)
Inferior nasal conchae
Category II Codes CPT
8. 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....
The Universal Claim Form
The St. Anthony Relative Value for Physicians (RVP)
Relative Value Payment Schedules Method
Flat bones
9. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Contracted Rates with MCOs
encounter form
Spinal/Vertebral Column
Unique Provider Identification Number (UPIN)
10. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
Liability insurance
Tabular List (Volume 1)...
sebaceous(oil) glands and the suddoriferous (sweat) glands
The Current Procedural Terminology (CPT)
11. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Long bones
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Employer Identification Number (EIN)
New patient
12. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Unspecified nature
Complicated
Benign
13. .. lower jaw bone.
Vesicle
Mandible
Wheal
The St. Anthony Relative Value for Physicians (RVP)
14. This is the inventory of the constitutional symptoms regarding the various body systems.
Eligibility
Review of Systems (ROS)
Group Insurance
Zygoma
15. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
The Universal Claim Form
Participating physician
New patient
Inferior nasal conchae
16. 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.
Full ROM
lunula
Medical Records
Medicare Claim Status
17. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Liability insurance
Employee Liability
Sesamoid bones
18. 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
Colles
Melanin
State License Number
Health practitioner
19. Is an electronic or paper-based report of payment sent by the payer to the provider.
Remittance Advice
stand-alone codes
Medical Records
HCPCS Level II codes (National Codes)
20. 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.
Clean claim
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Collagen
Pre-determination
21. Structural protein found in the skin and connective tissue
Collagen
Indemnity Insurance
-90 - Reference (Outside) Laboratory
Ulcermembranes
22. 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
Frontal Bone
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
bullet (a
Unauthorized benefit
23. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
Medical necessity
Ischium
New Patient
stand-alone codes
24. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Multigravida
Non-covered benefit
CPT SECTIONS.
Reasons for Documentation
25. 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
Sections
False ribs
Salter-Harris
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
26. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Ischium
History of present illness (HPI)
Accident
Relative Value Payment Schedules Method
27. 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.
Advance Beneficiary Notice
Category II Codes CPT
Tabular List (Volume 1)...
Musculoskeletal System
28. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Palatine bones
Neoplasm Table
Greenstick
Remittance Advice
29. Is one who has no contract with the health insurance plan.
Fee-for-Service
Indemnity Insurance
Nonparticipating physician
upper appendicular skeleton
30. - 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
CPT SECTIONS.
TRICARE PLANS
Medigap (Medicare Supplemental Insurance)
Accept assignment
31. 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
Wheal
Vomer
Modifiers
32. This is not specified as benign or malignant in the diagnosis or medical record.
Health Care Financing Administration Common Procedure Coding System
Unspecified (hypertension)
Sesamoid bones
Greenstick
33. The main term in the index may by followed by terms within parenthesis.
Medicare Claim Status
lunula
New patient
Alphabetic Index (Volume 2)
34. 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.
History of present illness (HPI)
False ribs
Paper Claim
Carpals
35. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Explanation of Benefits (EOB)
Mutually Exclusive Edits
Contracted Rates with MCOs
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
36. Mild or controlled hypertension and no damage to the vascular system or organs.
Benign (hypertension)
Accept assignment
Medigap (Medicare Supplemental Insurance)
Compression fracture
37. 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
Point-of-Service plan (POS)
Fissure
Vomer
Medicare
38. Absence of hair from areas where it normally grows
Outpatient
New Patient
Nodule
Alopecia
39. 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
essential modifiers
Evaluation and Management Review
Rejected claim
-90 - Reference (Outside) Laboratory
40. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
lunula
Maxilla
Group Insurance
Employee Liability
41. Is when two insurance companies work together to coordinate payment of the benefits.
Liability insurance
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Coordination of Benefits (COB)
MEDICARE Part A
42. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Outpatient
There are two types of sweat glands
Compliance Regulations
-51 - Multiple Procedures
43. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
ulna
Zygoma
Fiscal Intermediary
44. 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:
upper appendicular skeleton
Musculoskeletal System
Hypertension Table
Benign (hypertension)
45.
Pre-paid Health Plan
Physician
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
co-payment
46. major skin pigment
Melanin
The Integumentary System
Ethmoid Bone
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
47. 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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48. 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
Fissure
Carcinoma (Ca) in situ
Accident
Fee-for-Service
49. Number assigned to the physician by Medicare program.
Outpatient
Full ROM
Vesicle
Unique Provider Identification Number (UPIN)
50. Consists of the skull - rib cage - and spine
axial skeleton
Point-of-Service plan (POS)
Suicide Attempt
Non-covered benefit