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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
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. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Deductible
Outpatient
eponychium
History
2. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Hypertension Table
Collagen
Peer Review Organization (PRO)
3. Produce secretions that allow the body to be moisturized or cooled.
Ulcermembranes
sebaceous(oil) glands and the suddoriferous (sweat) glands
Chief complaint (CC)
MEDICARE Part C
4. 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.
Medical necessity
Established Patient
Palatine bones
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
5. 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
Medigap (Medicare Supplemental Insurance)
Invalid claim
Sphenoid Bones
Relative Value Payment Schedules Method
6. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
upper appendicular skeleton
New patient
Impetigo
Radius
7. The cuticle at the lower part of the nail and this is sometimes referred to as the
eponychium
Peer Review Organization (PRO)
Unique Provider Identification Number (UPIN)
Inferior nasal conchae
8. Upper jaw bone
Secondary malignancy
Maxilla
Subcategories
Carcinoma (Ca) in situ
9. Is the lateral lower arm bone (in line with the thumb).
Pathologic
Medicare
Radius
premium
10. Represents a new procedure or service code added since the previous edition of the manual.
Sphenoid Bones
Performing Provider Identification Number (PPIN)
itemized statement
bullet (a
11. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
stand-alone codes
-90 - Reference (Outside) Laboratory
Location Methods
Greenstick
12. Groove or crack like sore
Uncertain behavior
Fissure
co-payment
-32 - Mandated Services
13. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Eligibility
Capitated Rates
Exclusions and Limitations
Established patient
14. 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.
-90 - Reference (Outside) Laboratory
Suicide Attempt
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Malignant
15. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Review of Systems (ROS)
Full ROM
Evaluation and Management Review
Qualified diagnosis
16. 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
Civil Monetary Penalties Law (CMPL)
Surgical Package
Suicide Attempt
Location Methods
17. poisoning was inflicted by another person with intent to kill or injure
Chief complaint
Assault
Medical Records
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
18. Describes the services billed and includes a breakdown of how the payment is determined
Inpatient
Chief complaint
Humerus
Explanation of Benefits (EOB)
19. The poisoning was self-inflicted.
Established Patient
Malignant
-90 - Reference (Outside) Laboratory
Suicide Attempt
20. Pre-determined set of benefits covered under one set annual fee.
Clean claim
Chief complaint (CC)
Pre-paid Health Plan
Parietal Bones
21. This modifier is used when the same procedure is performed on a mirror-image part of the body..
-50 - Bilateral Procedure
Rib Cage
The St. Anthony Relative Value for Physicians (RVP)
Chief complaint
22. 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.
Sebaceous glands
Dirty claim
CPT SECTIONS.
Albino
23. 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.
Neoplasm Table
National Correct Coding Initiative (NCCI)
Retention of Medical Records
premium
24. 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
Keratin
sprain
Pubic bone
25. 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
False Claims Act (FCA)
MEDICARE Part A
Coinsurance
Workers Compensation
26. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve
Accident
Medical Records
Humerus
Past - family and social history (PFSH)
27. The lower anterior part of the bone
Sebaceous glands
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Established Patient
Pubic bone
28. solid - round or oval elevated lesion more than 1 cm in diameter
False Claims Act (FCA)
Civil Monetary Penalties Law (CMPL)
Nodule
Uncertain behavior
29. is a traumatic injury to a joint involving the soft tissue.
stand-alone codes
Employer Identification Number (EIN)
sprain
Unspecified (hypertension)
30. 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'.
Category II Codes CPT
Reasons for Documentation
Pre-authorization
axial skeleton
31. 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.
Remittance Advice
Benign (hypertension)
Temporal Bone
triangle (a
32. Poisoning cannot be determined whether intentional or accidental.
Undetermined
Comminuted fracture
Inferior nasal conchae
There are three layers to the skin
33. 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
Blue Cross/Blue Shield Plans
Outpatient
Pathologic
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
34. The poisoning was self-inflicted.
Suicide Attempt
Remittance Advice
Ulcermembranes
bullet (a
35. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Modifiers
essential modifiers
bullet (a
Inferior nasal conchae
36. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Categorically needy -MEDICAID
Limited ROM
Flat bones
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
37. 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.
Primary malignancy
MEDICARE Part C
Colles
Lipocyte
38. is defined as one who has not received any medical services within the last three years.
New Patient
Compression fracture
Lipocyte
Albino
39. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Pelvis
New patient
Accept assignment
Modifiers
40. poisoning was inflicted by another person with intent to kill or injure
The Universal Claim Form
Assault
Health Maintenance Organization (HMO)
Polyp
41. forms the roof of the nasal cavity.
-50 - Bilateral Procedure
Limited ROM
Ethmoid Bone
Unlisted Procedures Procedures
42. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Mutually Exclusive Edits
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Established patient
Advance Beneficiary Notice
43. The fractured area of bone collapses on itself.
ulna
Preferred Provider plan
TRICARE
Compression fracture
44. 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
Complicated
Qualified diagnosis
Nonparticipating physician
45. 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.
Non-covered benefit
Humerus
Carcinoma (Ca) in situ
Clearinghouse
46. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
Modifiers
Personal Insurance
Medicare Claim Status
47. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Categorically needy -MEDICAID
MEDICARE Part B
MEDICARE Part C
true ribs
48. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve
Primary malignancy
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Unspecified nature
Accident
49. 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
Social Security Number
Benign (hypertension)
Paper Claim
stand-alone codes
50. 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
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Chief complaint (CC)
Medicaid
Health practitioner