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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. 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
Medically needy
Neoplasm Table
Radius
TRICARE PLANS
2. 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
Liability insurance
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Gender rule
Past - family and social history (PFSH)
3. forms the two lower sides of the cranium.
Reasons for Documentation
Unique Provider Identification Number (UPIN)
Humerus
Temporal Bone
4. Is a working diagnosis which is not yet established.
stand-alone codes
sprain
Category I Codes CPT
Qualified diagnosis
5. 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.
nonessential modifiers
Lacrimal bones
Dirty claim
Nodule
6. anterior to the temporal bones.
Category I Codes CPT
Sphenoid Bones
Abuse
Coordination of Benefits (COB)
7. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
Long bones
MEDICAID COVERAGE
Malignant
Coordination of Benefits (COB)
8. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Accident
Wheal
Clean claim
Paper Claim
9. Upper jaw bone
Maxilla
Preferred Provider Organization (PPO)
Indemnity Insurance
Workers Compensation
10. Absence of hair from areas where it normally grows
Alopecia
Gangrene
New Patient
Vomer
11. The lower anterior part of the bone
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Vesicle
Pubic bone
Compression fracture
12. The moon like white area at the base of the nail.
Established patient
lunula
Non-covered benefit
Eligibility
13. .. lower jaw bone.
Mandible
Uncertain behavior
Coding
Tabular List (Volume 1)...
14. uncertain whether benign or malignant; borderline malignancy
circle with a line through it)
Sebaceous glands
Past - family and social history (PFSH)
Uncertain behavior
15. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
encounter form
Group Insurance
Multigravida
Exclusions and Limitations
16. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Commercial Carriers
Alopecia
Mutually Exclusive Edits
The Current Procedural Terminology (CPT)
17. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
Coordination of Benefits (COB)
MEDICARE Part D
phalanges (phalanx.s)
The Universal Claim Form
18. Typically not used on the claim form unless the provider does not have an EIN.
Social Security Number
History of present illness (HPI)
Group Provider Number
Performing Provider Identification Number (PPIN)
19. Numbers 1-7 - attach directly to the sternum in the front of the body.
true ribs
Short bones
Suicide Attempt
Group Insurance
20. 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
-51 - Multiple Procedures
Point-of-Service plan (POS)
Clearinghouse
sprain
21. 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
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
The Current Procedural Terminology (CPT)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Fee-for-Service
22. the bone is broken and the ends are driven into each other.
Coordination of Benefits (COB)
Lipocyte
Impacted
Outpatient
23. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
-50 - Bilateral Procedure
False Claims Act (FCA)
Contracted Rates with MCOs
Carcinoma (Ca) in situ
24. 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.
Group practice
Established Patient
ligaments
Employee Liability
25. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Evaluation and Management Review
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Exclusions and Limitations
26. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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27. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Preferred Provider plan
Sub classification
Category III Codes CPT
axial skeleton
28. This is a set of information the physician gathers from the patient regarding the following:
Clearinghouse
Macule
History
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
29. 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)
Outpatient
Gangrene
Inferior nasal conchae
30. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
Medicare
phalanges (phalanx.s)
Blue Cross/Blue Shield Plans
Column 1/Column 2 (previously called Comprehensive/Component) Edits
31. major skin pigment
TRICARE
Melanin
-32 - Mandated Services
Medical Records
32. Most billing-related cases are based on HIPAA and False Claims Act.
The Patient Care Partnership (Patient's Bill of Rights)
TRICARE PLANS
Carcinoma (Ca) in situ
Compliance Regulations
33. 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
Established patient
lunula
Workers Compensation
sprain
34. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Benign
Exclusions and Limitations
MEDICARE Part A
Physician
35. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
MEDICARE Part B
The Good Samaritan Act
Primary malignancy
nonessential modifiers
36. Make up part of the interior of the nose.
Medical Records
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Pre-paid Health Plan
Inferior nasal conchae
37. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Patient Confidentiality
HCPCS Level I codes
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
38. 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
Salter-Harris
Rejected claim
Category II Codes CPT
Liability insurance
39. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu
Ethmoid Bone
Blue Cross/Blue Shield Plans
Pre-certification
Physician
40. open sore on the skin or mucous
lunula
Frontal Bone
-99 - Multiple Modifiers
Ulcermembranes
41. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Patient Confidentiality
-50 - Bilateral Procedure
New Patient
Electronic Claim
42. 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
Alphabetic Index (Volume 2)
Patient Confidentiality
Full ROM
43. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Melanin
Qualified diagnosis
Personal Insurance
Chapters
44. Is an electronic or paper-based report of payment sent by the payer to the provider.
Chief complaint (CC)
Remittance Advice
Radius
National Correct Coding Initiative (NCCI)
45. Further classified as to primary - secondary - or carcinoma in situ.
Fraud
Paper Claim
Malignant
Musculoskeletal System
46. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Categories
Provider Identification Number (PIN)
Point-of-Service plan (POS)
Flat bones
47. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.
Unique Provider Identification Number (UPIN)
Uncertain behavior
Pre-determination
triangle (a
48. The cuticle at the lower part of the nail and this is sometimes referred to as the
Vesicle
The Integumentary System
eponychium
Civil Monetary Penalties Law (CMPL)
49. 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.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Personal Insurance
ulna
Employer Identification Number (EIN)
50. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
There are two types of sweat glands
appendicular skeleton .
Employer Liability
Accept assignment