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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.
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. Upper jaw bone
Maxilla
-26 - Professional Component
Temporal Bone
Keratin
2. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
phalanges (phalanx.s)
Disability insurance
Medicare Claim Status
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
3. Noninvasive - non-spreading - nonmalignant
Fraud
Benign
No ROM
Group practice
4. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Coinsurance
Unspecified (hypertension)
Lipocyte
Fraud
5. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Pubic bone
Disability insurance
Add-on codes
6. 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.
Unique Provider Identification Number (UPIN)
Clean claim
Hairline
Employer Liability
7. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin
-51 - Multiple Procedures
Workers Compensation
Rejected claim
Patient Confidentiality
8. 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 -
The Current Procedural Terminology (CPT)
nonessential modifiers
Remittance Advice
essential modifiers
9. 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.
Hypertension Table
Lacrimal bones
Dirty claim
Eligibility
10. death of tissue associated with loss of blood supply
true ribs
ligaments
Gangrene
sprain
11. forms the two lower sides of the cranium.
Tabular List (Volume 1)...
Abuse
Categories
Temporal Bone
12. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Temporal Bone
sebaceous(oil) glands and the suddoriferous (sweat) glands
Medicare
13. 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.
Impacted
Neoplasm Table
Non-covered benefit
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
14. 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
The Integumentary System
Subcategories
Civil Monetary Penalties Law (CMPL)
Full ROM
15. A fat cell
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Lipocyte
Medically needy
Outpatient
16. 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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17. The bone is broken and pierces an internal organ
Pre-paid Health Plan
Complicated
Medicaid
Gangrene
18. 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.
History
Category II Codes CPT
Sections
New patient
19. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Categorically needy -MEDICAID
The Current Procedural Terminology (CPT)
Workers Compensation
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
20. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
The Current Procedural Terminology (CPT)
New patient
Fiscal Intermediary
Personal Insurance
21. Poisoning cannot be determined whether intentional or accidental.
Rejected claim
Accident
Medicaid
Undetermined
22. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Health practitioner
MEDICARE Part A
Qualified diagnosis
Outpatient
23. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
National Correct Coding Initiative (NCCI)
Past - family and social history (PFSH)
itemized statement
Polyp
24. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
MEDICARE Part C
Point-of-Service plan (POS)
State License Number
25. Any fracture occurring spontaneously as a result of disease.
Pathologic
Sebaceous glands
Medically needy
Pre-determination
26. 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
A plus sign (+)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Pubic bone
Employer Liability
27. 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.
-90 - Reference (Outside) Laboratory
False ribs
Medical Records
Sesamoid bones
28. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Advance Beneficiary Notice
Contracted Rates with MCOs
Gangrene
29. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
MEDICARE Part A
Wheal
Gender rule
Occipital Bone
30. 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
Electronic Claim
Coordination of Benefits (COB)
Pelvis
Lipocyte
31. make up part of the roof of the mouth
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Unspecified nature
Palatine bones
MEDICARE Part C
32. forms the roof of the nasal cavity.
Gender rule
encounter form
Ethmoid Bone
Accept assignment
33. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.
Group Provider Number
MEDICAID COVERAGE
MEDICARE Part C
ligaments
34. The lower anterior part of the bone
Health Care Financing Administration Common Procedure Coding System
Category III Codes CPT
Pubic bone
The Current Procedural Terminology (CPT)
35. The fractured area of bone collapses on itself.
Unlisted Procedures Procedures
Group Provider Number
Compression fracture
Advance Beneficiary Notice
36. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
circle with a line through it)
itemized statement
Employee Liability
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
37. Number assigned to the physician by Medicare program.
Unique Provider Identification Number (UPIN)
Medicaid
Coordination of Benefits (COB)
Contracted Rates with MCOs
38. forms the two lower sides of the cranium.
-51 - Multiple Procedures
Relative Value Payment Schedules Method
Temporal Bone
Coding
39. 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
National Correct Coding Initiative (NCCI)
Gangrene
Health Maintenance Organization (HMO)
Health practitioner
40. 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
Pathologic
The Good Samaritan Act
Group Insurance
41. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
Fee Schedule
Occipital Bone
HCPCS Level II codes (National Codes)
nonessential modifiers
42. Forms the sides of the cranium
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Assault
Parietal Bones
circle with a line through it)
43. Law passed by the federal government to prosecute cases of Medicaid fraud.
Lipocyte
Civil Monetary Penalties Law (CMPL)
Impacted
Sub classification
44. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Chief complaint
There are two types of sweat glands
Occipital Bone
Pre-paid Health Plan
45. solid - round or oval elevated lesion more than 1 cm in diameter
Past - family and social history (PFSH)
The Universal Claim Form
Social Security Number
Nodule
46. 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
Impacted
Nodule
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
A plus sign (+)
47. Is the lower medial arm bone.
Keratin
Secondary malignancy
ulna
No ROM
48. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
State License Number
Keratin
Temporal Bone
The St. Anthony Relative Value for Physicians (RVP)
49. 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
Health Care Financing Administration Common Procedure Coding System
Fraud
Sebaceous glands
Rib Cage
50. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Category I Codes CPT
stand-alone codes
Physician
Abuse