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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. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Coinsurance
Uncertain behavior
The Good Samaritan Act
Humerus
2. Is the lower medial arm bone.
ulna
Wheal
Category I Codes CPT
Employer Identification Number (EIN)
3. 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 Provider Number
Alopecia
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Occipital Bone
4. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
MEDICARE Part D
Category III Codes CPT
History
Impetigo
5. 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
Modifiers
Consultation
Birthday rule
Fraud
6. requires investigation and needs further clarification.
Workers Compensation
Point-of-Service plan (POS)
Peer Review Organization (PRO)
Rejected claim
7. open sore on the skin or mucous
Coinsurance
Ulcermembranes
Clearinghouse
Dirty claim
8. Absence of hair from areas where it normally grows
Melanin
Inpatient
Alopecia
Social Security Number
9. .. lower jaw bone.
Coding
Contracted Rates with MCOs
Mandible
-51 - Multiple Procedures
10. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Unspecified nature
Melanin
Two triangular symbols (a
Rib Cage
11. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Past - family and social history (PFSH)
ligaments
HCPCS Level I codes
triangle (a
12. 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
Employer Identification Number (EIN)
Paper Claim
Uncertain behavior
Commercial Carriers
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.
There are two types of sweat glands
Alopecia
Musculoskeletal System
Performing Provider Identification Number (PPIN)
14. Discolored - flat lesion (freckles - tattoo marks)
Electronic Claim
Parietal Bones
Macule
Clean claim
15. '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
Albino
Maxilla
axial skeleton
Employee Liability
16. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
The Patient Care Partnership (Patient's Bill of Rights)
Rib Cage
Employer Liability
Categorically needy -MEDICAID
17. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual
Gangrene
Fraud
Health practitioner
Fee Schedule
18. 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
appendicular skeleton .
Complicated
Paper Claim
19. The reason the patient came to see the physician.
Non-covered benefit
Chief complaint (CC)
Colles
History of present illness (HPI)
20. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Consultation
Remittance Advice
Unlisted Procedures Procedures
Sesamoid bones
21. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
There are three layers to the skin
Pre-determination
Social Security Number
Civil Monetary Penalties Law (CMPL)
22. Cheekbone
Zygoma
Melanin
Outpatient
Hairline
23. The fractured area of bone collapses on itself.
Category I Codes CPT
Compression fracture
stand-alone codes
Chief complaint (CC)
24. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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25. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Personal Insurance
nonessential modifiers
Wheal
bullet (a
26. forms the two lower sides of the cranium.
Temporal Bone
Suicide Attempt
Hypertension Table
Inferior nasal conchae
27. Typically not used on the claim form unless the provider does not have an EIN.
Benign
eponychium
true ribs
Social Security Number
28. 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.
Patient Confidentiality
Benign (hypertension)
Vomer
Section 3 Index to External Causes of Injury (E codes)
29. paired bones at the corner of each eye that cradle the tear ducts.
Invalid claim
Lacrimal bones
Macule
New Patient
30. Poisoning cannot be determined whether intentional or accidental.
Pubic bone
Mutually Exclusive Edits
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Undetermined
31. 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.
Explanation of Benefits (EOB)
Fissure
New patient
Accident
32. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Benign
Tabular List (Volume 1)...
sprain
MEDICARE Part C
33. Small collection of clear fluid;blister
Vesicle
Electronic Claim
Neoplasm Table
Medigap (Medicare Supplemental Insurance)
34. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Location Methods
Collagen
Polyp
Deductible
35.
Explanation of Benefits (EOB)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Musculoskeletal System
Long bones
36. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Neoplasm Table
Mutually Exclusive Edits
Retention of Medical Records
False ribs
37. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:
Invalid claim
Hypertension Table
Birthday rule
Gangrene
38. The physician must obtain this number in order to practice within a state.
State License Number
-51 - Multiple Procedures
Coordination of Benefits (COB)
Fiscal Intermediary
39. 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
Suicide Attempt
Point-of-Service plan (POS)
The Current Procedural Terminology (CPT)
Group Provider Number
40. Are conditions - situations - and services not covered by the insurance carrier.
The Patient Care Partnership (Patient's Bill of Rights)
upper appendicular skeleton
Parietal Bones
Exclusions and Limitations
41. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
No ROM
Spinal/Vertebral Column
Inpatient
Macule
42. 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
Fraud
Invalid claim
-90 - Reference (Outside) Laboratory
Palatine bones
43. 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
Social Security Number
Past - family and social history (PFSH)
Unspecified (hypertension)
Sub classification
44. '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
Review of Systems (ROS)
Unspecified nature
Employee Liability
Surgical Package
45. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Employer Liability
Disability insurance
Chief complaint
Column 1/Column 2 (previously called Comprehensive/Component) Edits
46. 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.
Section 3 Index to External Causes of Injury (E codes)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Category III Codes CPT
Suicide Attempt
47. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fiscal Intermediary
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Invalid claim
Palatine bones
48. major skin pigment
Chief complaint
Vesicle
Melanin
Comminuted fracture
49. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
The St. Anthony Relative Value for Physicians (RVP)
Gangrene
Complicated
co-payment
50. 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
Liability insurance
Birthday rule
Lipocyte
Pathologic