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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. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
Undetermined
Full ROM
Group practice
Fraud
2. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
Invalid claim
Alphabetic Index (Volume 2)
Disability insurance
Gangrene
3. Pre-determined set of benefits covered under one set annual fee.
Unlisted Procedures Procedures
Unspecified (hypertension)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Pre-paid Health Plan
4. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
The Universal Claim Form
Uncertain behavior
Group practice
Chief complaint (CC)
5. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Retention of Medical Records
Employer Identification Number (EIN)
Alphabetic Index (Volume 2)
Lacrimal bones
6. Groove or crack like sore
Fissure
Health Maintenance Organization (HMO)
Ethmoid Bone
Unauthorized benefit
7. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)
Colles
Fee-for-Service
co-payment
Ischium
8. 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
co-payment
HCPCS Level II codes (National Codes)
Sebaceous glands
Sesamoid bones
9. 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.
MEDICAID COVERAGE
Collagen
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Category II Codes CPT
10. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Mandible
Past - family and social history (PFSH)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
MEDICAID COVERAGE
11. The poisoning was self-inflicted.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Suicide Attempt
Pre-paid Health Plan
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
12. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Sub classification
Liability insurance
Category I Codes CPT
TRICARE PLANS
13. 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.
-32 - Mandated Services
Compliance Regulations
Abuse
Group practice
14. 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....
Reasons for Documentation
Pre-determination
Established patient
Coordination of Benefits (COB)
15. The physician must obtain this number in order to practice within a state.
State License Number
Chief complaint
Ischium
Employer Liability
16. 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
Group Insurance
Health Care Financing Administration Common Procedure Coding System
Occipital Bone
A plus sign (+)
17. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
-51 - Multiple Procedures
Performing Provider Identification Number (PPIN)
Birthday rule
Personal Insurance
18. uncertain whether benign or malignant; borderline malignancy
Albino
The Patient Care Partnership (Patient's Bill of Rights)
Uncertain behavior
Carpals
19. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
bullet (a
Pre-authorization
Chief complaint
-32 - Mandated Services
20. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
MEDICARE Part C
Birthday rule
Temporal Bone
Group practice
21. 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.
Colles
Performing Provider Identification Number (PPIN)
co-payment
Remittance Advice
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.
Impacted
Macule
Dirty claim
Established patient
23. 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
lunula
Capitated Rates
sprain
State License Number
24. 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.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
premium
No ROM
Modifiers
25. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Neoplasm Table
Qualified diagnosis
Carcinoma (Ca) in situ
Birthday rule
26. 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 I Codes CPT
Hypertension Table
Pre-authorization
Sphenoid Bones
27. 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
axial skeleton
The Current Procedural Terminology (CPT)
encounter form
MEDICARE Part D
28. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Group practice
axial skeleton
Mutually Exclusive Edits
Exclusions and Limitations
29. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Health Insurance Portability and Accountability Act (HIPAA)
Coding
Vomer
-90 - Reference (Outside) Laboratory
30. 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.
Frontal Bone
Sesamoid bones
The St. Anthony Relative Value for Physicians (RVP)
Fee Schedule
31. Structural protein found in the skin and connective tissue
Multigravida
Personal Insurance
There are two types of sweat glands
Collagen
32. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
co-payment
appendicular skeleton .
stand-alone codes
33. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
There are two types of sweat glands
Deductible
Clearinghouse
circle with a line through it)
34. 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
Medicare Claim Status
The Integumentary System
Section 3 Index to External Causes of Injury (E codes)
35. Is the qualifying factor or factors that must be met before a patient receives benefits.
Two triangular symbols (a
Eligibility
Unspecified (hypertension)
Fee-for-Service
36. 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
Advance Beneficiary Notice
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Disability insurance
New patient
37. forms the roof of the nasal cavity.
TRICARE
MEDICARE Part A
Ethmoid Bone
Modifiers
38. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Accept assignment
Pre-determination
Long bones
Sesamoid bones
39. 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
Evaluation and Management Review
Medical Records
upper appendicular skeleton
Capitated Rates
40. anterior to the temporal bones.
Sphenoid Bones
Inferior nasal conchae
There are two types of sweat glands
stand-alone codes
41. represents Exemption from the use of modifier -51
Zygoma
Medigap (Medicare Supplemental Insurance)
Employee Liability
circle with a line through it)
42. 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
Long bones
Flat bones
Liability insurance
Contracted Rates with MCOs
43. 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
Categorically needy -MEDICAID
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Macule
Sesamoid bones
44. is a traumatic injury to a joint involving the soft tissue.
Chapters
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
MEDICARE Part C
sprain
45. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Malignant
circle with a line through it)
New patient
State License Number
46. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
itemized statement
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
premium
Preferred Provider Organization (PPO)
47. Typically not used on the claim form unless the provider does not have an EIN.
Paper Claim
Social Security Number
Group practice
HCPCS Level I codes
48. 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
Short bones
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Deductible
Electronic Claim
49. 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
phalanges (phalanx.s)
Health Maintenance Organization (HMO)
False Claims Act (FCA)
sprain
50. A fat cell
Mutually Exclusive Edits
sprain
premium
Lipocyte