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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. Represent changes in the text or definition between the triangles.
Compliance Regulations
Two triangular symbols (a
MEDICARE Part C
premium
2. Is made up of the shoulder - collar - pelvic and arms and legs
Suicide Attempt
Preferred Provider Organization (PPO)
appendicular skeleton .
Established patient
3. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
HCPCS Level I codes
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Abuse
Employer Liability
4. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Musculoskeletal System
Colles
Indemnity Insurance
Complicated
5. Indicates add-on codes
A plus sign (+)
The Universal Claim Form
Medicare
Subcategories
6. solid - round or oval elevated lesion more than 1 cm in diameter
MEDICARE Part A
Disability insurance
Health practitioner
Nodule
7. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
MEDICARE Part D
Greenstick
8. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
-26 - Professional Component
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
phalanges (phalanx.s)
Reasons for Documentation
9. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
lunula
stand-alone codes
phalanges (phalanx.s)
HCPCS Level I codes
10. 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.
Non-covered benefit
Pelvis
Tabular List (Volume 1)...
triangle (a
11. 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
-99 - Multiple Modifiers
Occipital Bone
Neoplasm Table
Employer Liability
12. make up part of the roof of the mouth
Health Maintenance Organization (HMO)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Paper Claim
Palatine bones
13. Number assigned to the physician by Medicare program.
Unique Provider Identification Number (UPIN)
Social Security Number
Maxilla
Explanation of Benefits (EOB)
14. Is the lateral lower arm bone (in line with the thumb).
stand-alone codes
Impacted
CPT SECTIONS.
Radius
15. Is the upper arm bone.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
lunula
Uncertain behavior
Humerus
16. 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 II Codes CPT
Benign
Palatine bones
Pre-authorization
17. 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.
Dirty claim
Humerus
itemized statement
Clean claim
18. Forms the anterior part of the skull and the forehead
Frontal Bone
Established patient
ligaments
Employee Liability
19. 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.
Dirty claim
Limited ROM
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Undetermined
20. 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
The St. Anthony Relative Value for Physicians (RVP)
Birthday rule
TRICARE PLANS
Impacted
21. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.
Non-covered benefit
upper appendicular skeleton
Physician
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
22. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
CPT SECTIONS.
The Patient Care Partnership (Patient's Bill of Rights)
Pre-authorization
Alphabetic Index (Volume 2)
23. is defined as one who has not received any medical services within the last three years.
New Patient
Malignant
Fee Schedule
Reasons for Documentation
24. Is when two insurance companies work together to coordinate payment of the benefits.
circle with a line through it)
Coordination of Benefits (COB)
Pre-paid Health Plan
Inpatient
25. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).
sprain
Comminuted fracture
Sections
Limited ROM
26. Absence of hair from areas where it normally grows
Non-covered benefit
Alopecia
Location Methods
Impacted
27. 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
Compliance Regulations
Category I Codes CPT
HCPCS Level II codes (National Codes)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
28. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Temporal Bone
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Preferred Provider plan
Medicare
29. 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
Pre-authorization
Liability insurance
Undetermined
Primary malignancy
30. Are composed of three-digit codes representing a single disease or condition.
Established Patient
Coinsurance
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Categories
31. 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
The St. Anthony Relative Value for Physicians (RVP)
Accident
Explanation of Benefits (EOB)
Electronic Claim
32. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Modifiers
False Claims Act (FCA)
circle with a line through it)
Employer Identification Number (EIN)
33. Superior and widest bone
Pelvis
Tabular List (Volume 1)...
Ulcermembranes
Zygoma
34. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
TRICARE
Primary malignancy
triangle (a
lunula
35. 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.
Pathologic
Employer Liability
Category II Codes CPT
MEDICAID COVERAGE
36. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Remittance Advice
False ribs
Employer Identification Number (EIN)
Benign (hypertension)
37. The fractured area of bone collapses on itself.
Compression fracture
appendicular skeleton .
sebaceous(oil) glands and the suddoriferous (sweat) glands
Liability insurance
38. - 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.
Hypertension Table
Fissure
Gender rule
Unauthorized benefit
39. 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
Outpatient
New Patient
Patient Confidentiality
Uncertain behavior
40. Upper jaw bone
Maxilla
New Patient
Employer Liability
There are three layers to the skin
41. 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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42. 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
Sub classification
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Gender rule
New Patient
43. male of household is primary payer
MEDICARE Part C
Group Insurance
Gender rule
MEDICARE Part C
44. 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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45. Cheekbone
Collagen
Alphabetic Index (Volume 2)
Sections
Zygoma
46. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
-32 - Mandated Services
Established Patient
Medical Records
47. Superior and widest bone
Pre-certification
Pelvis
Malignant
Uncertain behavior
48. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
nonessential modifiers
False Claims Act (FCA)
axial skeleton
The Integumentary System
49. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
Relative Value Payment Schedules Method
Macule
Section 3 Index to External Causes of Injury (E codes)
Fissure
50. major skin pigment
Melanin
Humerus
Hypertension Table
Chief complaint