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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. Is made up of the shoulder - collar - pelvic and arms and legs
The St. Anthony Relative Value for Physicians (RVP)
Medical Records
appendicular skeleton .
upper appendicular skeleton
2. numbers 8-10 - are attached to the sternum by cartilage
Pre-paid Health Plan
False ribs
Vesicle
-90 - Reference (Outside) Laboratory
3. - 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
Liability insurance
False Claims Act (FCA)
Medigap (Medicare Supplemental Insurance)
Unique Provider Identification Number (UPIN)
4. uncertain whether benign or malignant; borderline malignancy
Uncertain behavior
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
HCPCS Level II codes (National Codes)
Medicare Claim Status
5. 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
Suicide Attempt
Health Insurance Portability and Accountability Act (HIPAA)
-50 - Bilateral Procedure
The Universal Claim Form
6. Number assigned to the physician by Medicare program.
Vomer
Clearinghouse
Unique Provider Identification Number (UPIN)
Colles
7. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Relative Value Payment Schedules Method
Carcinoma (Ca) in situ
Zygoma
Gangrene
8. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Fee-for-Service
Social Security Number
HCPCS Level I codes
Workers Compensation
9. 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
Unlisted Procedures Procedures
Ischium
Location Methods
Compression fracture
10. 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
HCPCS Level I codes
Pre-paid Health Plan
Peer Review Organization (PRO)
11. Is when two insurance companies work together to coordinate payment of the benefits.
Long bones
Coordination of Benefits (COB)
Reasons for Documentation
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
12. 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
Liability insurance
Malignant
Point-of-Service plan (POS)
Outpatient
13. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Medical Records
Primary malignancy
False Claims Act (FCA)
Chapters
14. The cuticle at the lower part of the nail and this is sometimes referred to as the
Subcategories
Blue Cross/Blue Shield Plans
eponychium
-32 - Mandated Services
15. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
Medical necessity
Reasons for Documentation
Group practice
Health Care Financing Administration Common Procedure Coding System
16. forms the roof of the nasal cavity.
Hypertension Table
False ribs
Employee Liability
Ethmoid Bone
17. 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
ulna
Categorically needy -MEDICAID
Neoplasm Table
Electronic Claim
18. 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
The Current Procedural Terminology (CPT)
Tabular List (Volume 1)...
Carcinoma (Ca) in situ
Collagen
19. 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
co-payment
The Universal Claim Form
phalanges (phalanx.s)
HCPCS Level II codes (National Codes)
20. 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.
Polyp
Pre-authorization
Non-covered benefit
Temporal Bone
21. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Pre-authorization
Clearinghouse
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Past - family and social history (PFSH)
22. Forms the anterior part of the skull and the forehead
History of present illness (HPI)
Sebaceous glands
Frontal Bone
Group practice
23. 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
Physician
Accident
Assault
Clean claim
24. Law passed by the federal government to prosecute cases of Medicaid fraud.
Civil Monetary Penalties Law (CMPL)
New Patient
Two triangular symbols (a
Sesamoid bones
25. 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
Pathologic
Preferred Provider Organization (PPO)
Neoplasm Table
Unspecified nature
26. Cheekbone
Employer Identification Number (EIN)
Indemnity Insurance
Zygoma
MEDICARE Part B
27. The physician must obtain this number in order to practice within a state.
State License Number
Complicated
Chief complaint
Melanin
28. 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.
Salter-Harris
Preferred Provider Organization (PPO)
Dirty claim
Chapters
29. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
Medicare Claim Status
Palatine bones
HCPCS Level II codes (National Codes)
Section 3 Index to External Causes of Injury (E codes)
30. Numbers 1-7 - attach directly to the sternum in the front of the body.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Non-covered benefit
Consultation
true ribs
31. 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
MEDICARE Part B
Fee-for-Service
Subcategories
Category III Codes CPT
32. 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
Compression fracture
Advance Beneficiary Notice
Evaluation and Management Review
Paper Claim
33. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Malignant
phalanges (phalanx.s)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Flat bones
34. Is the lower medial arm bone.
Eligibility
ulna
axial skeleton
-99 - Multiple Modifiers
35. 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
Lipocyte
Fraud
-99 - Multiple Modifiers
Chapters
36. 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
No ROM
Short bones
Unlisted Procedures Procedures
Surgical Package
37. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Unauthorized benefit
nonessential modifiers
Sub classification
Lipocyte
38. 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.
Wheal
Long bones
Modifiers
Preferred Provider plan
39. 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
Uncertain behavior
Inferior nasal conchae
Group practice
The Integumentary System
40. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
Musculoskeletal System
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Add-on codes
Group Insurance
41. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Peer Review Organization (PRO)
Greenstick
Sections
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
42. 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
Assault
Clean claim
stand-alone codes
Subcategories
43. Consists of the skull - rib cage - and spine
Pelvis
Group Insurance
Employer Identification Number (EIN)
axial skeleton
44. is defined as one who has not received any medical services within the last three years.
Health Care Financing Administration Common Procedure Coding System
Retention of Medical Records
Participating physician
New Patient
45. death of tissue associated with loss of blood supply
Gangrene
Long bones
Albino
Humerus
46. 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.
Medicaid
Contracted Rates with MCOs
bullet (a
Advance Beneficiary Notice
47. the bone is broken and the ends are driven into each other.
Impacted
Sphenoid Bones
appendicular skeleton .
Clearinghouse
48. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Retention of Medical Records
Hairline
Blue Cross/Blue Shield Plans
encounter form
49. 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....
Location Methods
Categorically needy -MEDICAID
Established patient
Non-covered benefit
50. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Suicide Attempt
-51 - Multiple Procedures
Category III Codes CPT
encounter form
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