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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. 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.
Mandible
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Sesamoid bones
Hairline
2. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
ulna
Birthday rule
essential modifiers
3. 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
Pre-certification
Comminuted fracture
Maxilla
Electronic Claim
4. 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
Location Methods
phalanges (phalanx.s)
-99 - Multiple Modifiers
Rib Cage
5. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
Clean claim
Health Insurance Portability and Accountability Act (HIPAA)
Section 3 Index to External Causes of Injury (E codes)
MEDICARE Part B
6. 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..
co-payment
ligaments
Mutually Exclusive Edits
Musculoskeletal System
7. 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.
Group Provider Number
Medical Records
Primary malignancy
Benign
8. 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
Limited ROM
Undetermined
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Collagen
9. 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
Impacted
Subcategories
Explanation of Benefits (EOB)
Complicated
10. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
History of present illness (HPI)
Capitated Rates
The Current Procedural Terminology (CPT)
Consultation
11. 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.
Coinsurance
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Past - family and social history (PFSH)
Category II Codes CPT
12. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Medical Records
Carpals
Vomer
Disability insurance
13. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Medigap (Medicare Supplemental Insurance)
Performing Provider Identification Number (PPIN)
-99 - Multiple Modifiers
-50 - Bilateral Procedure
14. 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 -
Patient Confidentiality
Humerus
essential modifiers
Tabular List (Volume 1)...
15. 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
Capitated Rates
Employer Liability
Evaluation and Management Review
Reasons for Documentation
16. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Health Care Financing Administration Common Procedure Coding System
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Section 3 Index to External Causes of Injury (E codes)
Fee Schedule
17. Small collection of clear fluid;blister
Ulcermembranes
Unauthorized benefit
Vesicle
Limited ROM
18. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
-26 - Professional Component
Categorically needy -MEDICAID
Unlisted Procedures Procedures
Health Insurance Portability and Accountability Act (HIPAA)
19. Is the lateral lower arm bone (in line with the thumb).
Radius
Performing Provider Identification Number (PPIN)
Clean claim
Compression fracture
20. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Sphenoid Bones
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Modifiers
Deductible
21. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Nodule
Chief complaint
Musculoskeletal System
Deductible
22. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Accept assignment
Melanin
Invalid claim
Keratin
23. represents Exemption from the use of modifier -51
circle with a line through it)
Employer Liability
Commercial Carriers
Impetigo
24. represents Exemption from the use of modifier -51
Carcinoma (Ca) in situ
Radius
Nonparticipating physician
circle with a line through it)
25. Is when two insurance companies work together to coordinate payment of the benefits.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Coordination of Benefits (COB)
New patient
Uncertain behavior
26. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Nonparticipating physician
Abuse
HCPCS Level I codes
Fraud
27. 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
MEDICARE Part C
Subcategories
Parietal Bones
Medically needy
28. This is a set of information the physician gathers from the patient regarding the following:
Add-on codes
History of present illness (HPI)
Explanation of Benefits (EOB)
History
29. 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
Remittance Advice
Deductible
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Parietal Bones
30. requires investigation and needs further clarification.
New Patient
Contracted Rates with MCOs
Rejected claim
Carcinoma (Ca) in situ
31. Is an electronic or paper-based report of payment sent by the payer to the provider.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Remittance Advice
Compression fracture
Section 3 Index to External Causes of Injury (E codes)
32. 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
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Uncertain behavior
Nonparticipating physician
Neoplasm Table
33. 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
Civil Monetary Penalties Law (CMPL)
Category II Codes CPT
Occipital Bone
Secondary malignancy
34. 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.
sprain
Primary malignancy
Chapters
National Correct Coding Initiative (NCCI)
35. paired bones at the corner of each eye that cradle the tear ducts.
History
Lacrimal bones
Carpals
Unspecified (hypertension)
36. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Peer Review Organization (PRO)
Preferred Provider Organization (PPO)
Gender rule
37. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Category III Codes CPT
Employer Identification Number (EIN)
Paper Claim
The Patient Care Partnership (Patient's Bill of Rights)
38. 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
-51 - Multiple Procedures
Personal Insurance
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Polyp
39. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
nonessential modifiers
Capitated Rates
Mutually Exclusive Edits
Fraud
40. - 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.
Abuse
Unauthorized benefit
itemized statement
Health practitioner
41. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Long bones
Pathologic
Radius
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
42. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Benign (hypertension)
Participating physician
Undetermined
Evaluation and Management Review
43. Is the qualifying factor or factors that must be met before a patient receives benefits.
Eligibility
Employee Liability
Radius
Complicated
44. death of tissue associated with loss of blood supply
Subcategories
Health practitioner
Gangrene
Health Maintenance Organization (HMO)
45. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Invalid claim
Comminuted fracture
Palatine bones
46. 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.
nonessential modifiers
Long bones
Unspecified nature
Workers Compensation
47. The physician must obtain this number in order to practice within a state.
State License Number
Melanin
Wheal
Alphabetic Index (Volume 2)
48. Structural protein found in the skin and connective tissue
Sub classification
Collagen
Physician
MEDICARE Part D
49. 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
Wheal
Sub classification
Participating physician
Coordination of Benefits (COB)
50. Forms the sides of the cranium
Parietal Bones
Unique Provider Identification Number (UPIN)
The Good Samaritan Act
itemized statement