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Test your basic knowledge |
Medical Billing And Coding Vocab
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. Is the upper arm bone.
Categorically needy -MEDICAID
Humerus
Suicide Attempt
Reasons for Documentation
2. 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.
Established patient
Carcinoma (Ca) in situ
Non-covered benefit
sebaceous(oil) glands and the suddoriferous (sweat) glands
3. 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
Primary malignancy
Commercial Carriers
Chief complaint
MEDICARE Part B
4. 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
Lipocyte
Unauthorized benefit
Outpatient
Group Provider Number
5. 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
Sebaceous glands
Health Maintenance Organization (HMO)
Short bones
Gangrene
6. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Mutually Exclusive Edits
Rib Cage
Paper Claim
Health Maintenance Organization (HMO)
7. 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.
Non-covered benefit
Secondary malignancy
-99 - Multiple Modifiers
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
8. 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.
Primary malignancy
Peer Review Organization (PRO)
-26 - Professional Component
Fee Schedule
9. 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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10. 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).
Comminuted fracture
Two triangular symbols (a
Lipocyte
Sections
11. Is made up of the shoulder - collar - pelvic and arms and legs
Electronic Claim
Alopecia
-32 - Mandated Services
appendicular skeleton .
12. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Peer Review Organization (PRO)
Pre-paid Health Plan
upper appendicular skeleton
Wheal
13. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -
MEDICAID COVERAGE
essential modifiers
Modifiers
Secondary malignancy
14. Any fracture occurring spontaneously as a result of disease.
Pathologic
The Integumentary System
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Impetigo
15. is defined as one who has not received any medical services within the last three years.
Melanin
stand-alone codes
New Patient
Mandible
16. Noninvasive - non-spreading - nonmalignant
Fissure
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Rejected claim
Benign
17. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.
Pre-authorization
Unique Provider Identification Number (UPIN)
Lacrimal bones
Melanin
18. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Unspecified (hypertension)
MEDICARE Part D
CPT SECTIONS.
19. A pregnant woman who has had at least one previous pregnancy.
Multigravida
Medicare Claim Status
Employer Identification Number (EIN)
There are two types of sweat glands
20. 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.
HCPCS Level I codes
encounter form
itemized statement
Salter-Harris
21. 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
Chief complaint
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
circle with a line through it)
The Universal Claim Form
22. 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
Abuse
phalanges (phalanx.s)
Patient Confidentiality
Secondary malignancy
23. 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
Musculoskeletal System
Indemnity Insurance
Two triangular symbols (a
24. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.
Invalid claim
Ischium
The Universal Claim Form
triangle (a
25. 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
Employer Identification Number (EIN)
Collagen
Category I Codes CPT
26. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
The Integumentary System
Frontal Bone
Unspecified (hypertension)
27. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Occipital Bone
There are three layers to the skin
Impetigo
Comminuted fracture
28. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Pre-paid Health Plan
History
Ethmoid Bone
Health Insurance Portability and Accountability Act (HIPAA)
29. 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
Modifiers
Clearinghouse
Gender rule
Subcategories
30. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Uncertain behavior
Explanation of Benefits (EOB)
Personal Insurance
-90 - Reference (Outside) Laboratory
31. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Sphenoid Bones
Medical Records
Gangrene
Carcinoma (Ca) in situ
32. 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.'
Nonparticipating physician
Electronic Claim
Medical necessity
circle with a line through it)
33. Cheekbone
TRICARE
Zygoma
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
-26 - Professional Component
34. paired bones at the corner of each eye that cradle the tear ducts.
Categories
Lacrimal bones
MEDICARE Part C
true ribs
35. 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.
Radius
essential modifiers
History of present illness (HPI)
-32 - Mandated Services
36. 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
Sections
-99 - Multiple Modifiers
Unlisted Procedures Procedures
Salter-Harris
37. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
true ribs
History of present illness (HPI)
Established Patient
Non-covered benefit
38. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
Provider Identification Number (PIN)
MEDICARE Part C
Accident
Occipital Bone
39. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
New Patient
Relative Value Payment Schedules Method
Deductible
-50 - Bilateral Procedure
40. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
triangle (a
Participating physician
Lipocyte
Coding
41. paired bones at the corner of each eye that cradle the tear ducts.
Lacrimal bones
HCPCS Level II codes (National Codes)
eponychium
Modifiers
42. 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
Eligibility
circle with a line through it)
Medicare
43. Poisoning cannot be determined whether intentional or accidental.
False ribs
Spinal/Vertebral Column
Pre-certification
Undetermined
44. 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
Paper Claim
New Patient
Past - family and social history (PFSH)
Clearinghouse
45. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Two triangular symbols (a
Musculoskeletal System
Clearinghouse
Melanin
46. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
upper appendicular skeleton
MEDICARE Part B
Electronic Claim
Blue Cross/Blue Shield Plans
47. Pre-determined set of benefits covered under one set annual fee.
Pre-paid Health Plan
Explanation of Benefits (EOB)
Parietal Bones
Indemnity Insurance
48. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Abuse
Social Security Number
Remittance Advice
49. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Fiscal Intermediary
Long bones
Comminuted fracture
Alphabetic Index (Volume 2)
50. 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.
Group practice
nonessential modifiers
TRICARE PLANS
Civil Monetary Penalties Law (CMPL)
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