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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
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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. uncertain whether benign or malignant; borderline malignancy
Nonparticipating physician
Uncertain behavior
Keratin
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
2. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Fee-for-Service
Health Insurance Portability and Accountability Act (HIPAA)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Medicaid
3. 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
Fee-for-Service
circle with a line through it)
TRICARE PLANS
Unlisted Procedures Procedures
4. Represents a new procedure or service code added since the previous edition of the manual.
bullet (a
Maxilla
Malignant
Neoplasm Table
5. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
MEDICARE Part B
premium
-32 - Mandated Services
Indemnity Insurance
6. 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
Clearinghouse
bullet (a
sprain
Collagen
7. The reason the patient came to see the physician.
Impacted
Chief complaint (CC)
Evaluation and Management Review
Two triangular symbols (a
8. 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
Chapters
circle with a line through it)
Paper Claim
Medical necessity
9. The reason the patient came to see the physician.
Deductible
Chief complaint (CC)
Capitated Rates
Coordination of Benefits (COB)
10. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Medical Records
circle with a line through it)
-90 - Reference (Outside) Laboratory
Group practice
11. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
itemized statement
Hairline
Social Security Number
Categories
12. 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
Health practitioner
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Keratin
Health Insurance Portability and Accountability Act (HIPAA)
13. male of household is primary payer
Inferior nasal conchae
Outpatient
Pre-authorization
Gender rule
14. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.
Ethmoid Bone
Clean claim
Eligibility
Inpatient
15. 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
New Patient
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Medical Records
Preferred Provider plan
16. A fracture of the epiphyseal plate in children.
Salter-Harris
Ischium
Medicare Claim Status
Evaluation and Management Review
17. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Pathologic
Eligibility
Category II Codes CPT
Location Methods
18. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Location Methods
sebaceous(oil) glands and the suddoriferous (sweat) glands
Pre-certification
Fiscal Intermediary
19. 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)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Evaluation and Management Review
Explanation of Benefits (EOB)
20. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Coinsurance
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
The Integumentary System
Employee Liability
21. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Alphabetic Index (Volume 2)
Fraud
Point-of-Service plan (POS)
Impetigo
22. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Gangrene
Employer Identification Number (EIN)
Medicaid
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
23. 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
true ribs
Health practitioner
phalanges (phalanx.s)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
24. Is a working diagnosis which is not yet established.
Suicide Attempt
Qualified diagnosis
Unauthorized benefit
Medically needy
25. Poisoning cannot be determined whether intentional or accidental.
No ROM
Impacted
Uncertain behavior
Undetermined
26. .. lower jaw bone.
-99 - Multiple Modifiers
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Mandible
Rib Cage
27. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
The Integumentary System
Full ROM
Fee Schedule
Established Patient
28. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Sub classification
Medigap (Medicare Supplemental Insurance)
Hypertension Table
Column 1/Column 2 (previously called Comprehensive/Component) Edits
29. 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
Parietal Bones
Macule
Limited ROM
Evaluation and Management Review
30. open sore on the skin or mucous
Review of Systems (ROS)
Uncertain behavior
Commercial Carriers
Ulcermembranes
31. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Carcinoma (Ca) in situ
Tabular List (Volume 1)...
Location Methods
Medicare
32. 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 -
essential modifiers
Two triangular symbols (a
Personal Insurance
Pre-authorization
33. 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.'
Medical necessity
Fraud
Carcinoma (Ca) in situ
Dirty claim
34.
Compliance Regulations
Medigap (Medicare Supplemental Insurance)
Long bones
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
35. 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.
Carcinoma (Ca) in situ
Malignant
itemized statement
Non-covered benefit
36. 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
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Salter-Harris
Disability insurance
Established Patient
37. 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.
Malignant
premium
Non-covered benefit
Paper Claim
38. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Provider Identification Number (PIN)
-90 - Reference (Outside) Laboratory
MEDICARE Part A
Unspecified nature
39. A fracture of the epiphyseal plate in children.
False Claims Act (FCA)
The Integumentary System
-90 - Reference (Outside) Laboratory
Salter-Harris
40. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Keratin
Commercial Carriers
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Reasons for Documentation
41. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
MEDICARE Part C
Long bones
Medicare Claim Status
Disability insurance
42. 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(oil) glands and the suddoriferous (sweat) glands
Group Provider Number
Dirty claim
Clearinghouse
43. The bone is broken and pierces an internal organ
Compression fracture
Zygoma
Two triangular symbols (a
Complicated
44. Is the lateral lower arm bone (in line with the thumb).
Clean claim
Reasons for Documentation
Radius
Abuse
45. Absence of hair from areas where it normally grows
The Universal Claim Form
Alopecia
Contracted Rates with MCOs
Evaluation and Management Review
46. represents Exemption from the use of modifier -51
true ribs
Long bones
Malignant
circle with a line through it)
47. 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.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Physician
Accept assignment
Multigravida
48. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
Carcinoma (Ca) in situ
Gender rule
Employer Liability
Two triangular symbols (a
49. 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.
Established Patient
Performing Provider Identification Number (PPIN)
Unique Provider Identification Number (UPIN)
Category I Codes CPT
50. Absence of hair from areas where it normally grows
Alopecia
Section 3 Index to External Causes of Injury (E codes)
-26 - Professional Component
Rejected claim