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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. Mild or controlled hypertension and no damage to the vascular system or organs.
Humerus
Benign (hypertension)
The St. Anthony Relative Value for Physicians (RVP)
Zygoma
2. A pregnant woman who has had at least one previous pregnancy.
Sphenoid Bones
Categories
Carpals
Multigravida
3. Benign growth extending from the surface of the mucous membrane
National Correct Coding Initiative (NCCI)
Temporal Bone
Polyp
Benign (hypertension)
4. 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
Alopecia
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Add-on codes
5. 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
encounter form
Preferred Provider Organization (PPO)
Hairline
CPT SECTIONS.
6. 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
Group practice
Sub classification
Flat bones
Capitated Rates
7. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Assault
Alopecia
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Ischium
8. Is the qualifying factor or factors that must be met before a patient receives benefits.
Fee-for-Service
Birthday rule
Eligibility
Retention of Medical Records
9. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Coding
Paper Claim
Surgical Package
Hairline
10. 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
Electronic Claim
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Medigap (Medicare Supplemental Insurance)
MEDICARE Part D
11. is a traumatic injury to a joint involving the soft tissue.
Compliance Regulations
Radius
sprain
Salter-Harris
12. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Colles
Consultation
Impacted
13. '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
Social Security Number
Medicare Claim Status
Greenstick
Employee Liability
14. .. lower jaw bone.
Uncertain behavior
Mandible
Retention of Medical Records
Coding
15. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Group Insurance
Coinsurance
Wheal
eponychium
16. 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
A plus sign (+)
Compression fracture
Benign (hypertension)
17. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages
CPT SECTIONS.
-50 - Bilateral Procedure
The Universal Claim Form
Liability insurance
18. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
ligaments
Qualified diagnosis
Unspecified (hypertension)
Employer Identification Number (EIN)
19. 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.
axial skeleton
Employee Liability
Carpals
False Claims Act (FCA)
20. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
There are two types of sweat glands
Suicide Attempt
MEDICAID COVERAGE
Ulcermembranes
21. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Collagen
Subcategories
Coinsurance
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
22. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
Surgical Package
Contracted Rates with MCOs
Outpatient
Chapters
23. male of household is primary payer
eponychium
Coding
Assault
Gender rule
24. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi
Inpatient
New patient
The Universal Claim Form
Health Maintenance Organization (HMO)
25. are small with irregular shapes. They are found in the wrist and ankle.
itemized statement
Short bones
Primary malignancy
axial skeleton
26. Consists of the skull - rib cage - and spine
Alphabetic Index (Volume 2)
Primary malignancy
axial skeleton
Location Methods
27. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Alphabetic Index (Volume 2)
False ribs
MEDICARE Part D
28. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H
TRICARE
Limited ROM
Salter-Harris
Birthday rule
29. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
Established patient
sprain
nonessential modifiers
Secondary malignancy
30. 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.
Sebaceous glands
Gangrene
MEDICARE Part B
Medicare Claim Status
31. 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
Retention of Medical Records
Pelvis
Abuse
The Integumentary System
32. This is a set of information the physician gathers from the patient regarding the following:
Indemnity Insurance
Impetigo
False Claims Act (FCA)
History
33. forms the roof of the nasal cavity.
Sphenoid Bones
Pathologic
Ethmoid Bone
Surgical Package
34. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Abuse
HCPCS Level I codes
-51 - Multiple Procedures
Zygoma
35. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
MEDICARE Part C
Temporal Bone
Ethmoid Bone
Hairline
36. represents Exemption from the use of modifier -51
circle with a line through it)
Participating physician
Greenstick
Deductible
37. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
Accident
Indemnity Insurance
Column 1/Column 2 (previously called Comprehensive/Component) Edits
-32 - Mandated Services
38. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Health practitioner
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Capitated Rates
Surgical Package
39. The physician must obtain this number in order to practice within a state.
Civil Monetary Penalties Law (CMPL)
Frontal Bone
State License Number
Macule
40. Absence of hair from areas where it normally grows
-50 - Bilateral Procedure
Alopecia
Malignant
TRICARE
41. The fractured area of bone collapses on itself.
Hairline
Established patient
Compression fracture
Undetermined
42. 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).
Add-on codes
Provider Identification Number (PIN)
Sections
Chapters
43. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Fissure
Deductible
History of present illness (HPI)
Point-of-Service plan (POS)
44. 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
Sesamoid bones
Unauthorized benefit
Birthday rule
Surgical Package
45. 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
Coinsurance
Malignant
Reasons for Documentation
Temporal Bone
46. 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
Sections
Albino
Point-of-Service plan (POS)
stand-alone codes
47. 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
Clearinghouse
Sphenoid Bones
Salter-Harris
MEDICAID COVERAGE
48. 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.
upper appendicular skeleton
Non-covered benefit
Vesicle
Flat bones
49. 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
Point-of-Service plan (POS)
Alopecia
Neoplasm Table
Non-covered benefit
50. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Lacrimal bones
Mutually Exclusive Edits
Category III Codes CPT
HCPCS Level II codes (National Codes)