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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 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)
nonessential modifiers
Health practitioner
2. Indicates add-on codes
Nodule
Medical necessity
Occipital Bone
A plus sign (+)
3. Is the qualifying factor or factors that must be met before a patient receives benefits.
Subcategories
Eligibility
The Patient Care Partnership (Patient's Bill of Rights)
Vesicle
4. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Electronic Claim
Tabular List (Volume 1)...
Deductible
true ribs
5. 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:
Sesamoid bones
Hypertension Table
Medical necessity
False Claims Act (FCA)
6. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Category II Codes CPT
Participating physician
The Current Procedural Terminology (CPT)
Contracted Rates with MCOs
7. 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:
Compliance Regulations
False ribs
CPT SECTIONS.
Hypertension Table
8. 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 -
Indemnity Insurance
History of present illness (HPI)
Humerus
Benign
9. 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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10. 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
Surgical Package
-90 - Reference (Outside) Laboratory
HCPCS Level II codes (National Codes)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
11. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Carpals
Uncertain behavior
Physician
Impetigo
12. 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
Eligibility
Unauthorized benefit
MEDICARE Part A
Coinsurance
13.
Preferred Provider Organization (PPO)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Medical necessity
Melanin
14. The bone is broken and pierces an internal organ
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Complicated
TRICARE
MEDICARE Part A
15. 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
Radius
Fraud
Pubic bone
Preferred Provider plan
16. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
Assault
MEDICARE Part B
Medicare
Medicaid
17. 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 Current Procedural Terminology (CPT)
sebaceous(oil) glands and the suddoriferous (sweat) glands
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
TRICARE PLANS
18. 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.
Category III Codes CPT
Secondary malignancy
Commercial Carriers
Assault
19. 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
Group Insurance
Peer Review Organization (PRO)
Qualified diagnosis
20. 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.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Pre-certification
Inpatient
Capitated Rates
21. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Sesamoid bones
HCPCS Level I codes
Limited ROM
22. 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.
Health Maintenance Organization (HMO)
Assault
Health practitioner
National Correct Coding Initiative (NCCI)
23. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
itemized statement
Long bones
Gangrene
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
24. 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
Occipital Bone
Employer Liability
-51 - Multiple Procedures
Mandible
25. 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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26. 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.
Sesamoid bones
False Claims Act (FCA)
nonessential modifiers
Short bones
27. Is when two insurance companies work together to coordinate payment of the benefits.
Sections
Coordination of Benefits (COB)
-51 - Multiple Procedures
-32 - Mandated Services
28. 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.
Established Patient
MEDICARE Part D
Pubic bone
Two triangular symbols (a
29. Discolored - flat lesion (freckles - tattoo marks)
Macule
Accept assignment
The Good Samaritan Act
Sebaceous glands
30. represents Exemption from the use of modifier -51
New patient
Group Provider Number
circle with a line through it)
Colles
31. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Radius
-99 - Multiple Modifiers
32. 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.
-51 - Multiple Procedures
No ROM
Point-of-Service plan (POS)
National Correct Coding Initiative (NCCI)
33. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.
Surgical Package
Clearinghouse
triangle (a
-26 - Professional Component
34. is a traumatic injury to a joint involving the soft tissue.
Medicare Claim Status
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Health Maintenance Organization (HMO)
sprain
35. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Musculoskeletal System
The Universal Claim Form
Pelvis
HCPCS Level II codes (National Codes)
36. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
Capitated Rates
Medicare
MEDICARE Part C
Palatine bones
37. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
The Current Procedural Terminology (CPT)
Medically needy
Contracted Rates with MCOs
There are two types of sweat glands
38. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Abuse
Clearinghouse
Categories
Explanation of Benefits (EOB)
39. 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
Workers Compensation
Zygoma
Participating physician
Deductible
40. '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
Spinal/Vertebral Column
Group practice
Pre-certification
Employee Liability
41. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Consultation
Two triangular symbols (a
Established patient
phalanges (phalanx.s)
42. 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
Occipital Bone
The Good Samaritan Act
Coordination of Benefits (COB)
-26 - Professional Component
43. 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.
Consultation
circle with a line through it)
Personal Insurance
Palatine bones
44. .. lower jaw bone.
Advance Beneficiary Notice
Mandible
Contracted Rates with MCOs
Add-on codes
45. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Sub classification
Malignant
Pathologic
Unique Provider Identification Number (UPIN)
46. 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
axial skeleton
Lipocyte
Evaluation and Management Review
Mandible
47. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Uncertain behavior
Salter-Harris
eponychium
Flat bones
48. 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.
Pelvis
Advance Beneficiary Notice
Long bones
Fissure
49. 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
There are two types of sweat glands
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Hypertension Table
Chief complaint (CC)
50. Produce secretions that allow the body to be moisturized or cooled.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Blue Cross/Blue Shield Plans
Employer Identification Number (EIN)
Melanin