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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. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Temporal Bone
Secondary malignancy
The Integumentary System
Pre-certification
2. 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
Past - family and social history (PFSH)
Commercial Carriers
Fraud
Workers Compensation
3. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Benign (hypertension)
HCPCS Level I codes
Macule
Health Care Financing Administration Common Procedure Coding System
4. 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.
phalanges (phalanx.s)
Fee Schedule
Pre-determination
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
5. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve
Salter-Harris
Compression fracture
MEDICARE Part A
Accident
6. anterior to the temporal bones.
Fiscal Intermediary
-50 - Bilateral Procedure
Group Insurance
Sphenoid Bones
7. .. lower jaw bone.
Relative Value Payment Schedules Method
Mandible
Established Patient
true ribs
8. 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.
New patient
Rib Cage
Collagen
Surgical Package
9. 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).
Chapters
MEDICARE Part A
Nodule
Peer Review Organization (PRO)
10. '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
Consultation
Point-of-Service plan (POS)
Employee Liability
The St. Anthony Relative Value for Physicians (RVP)
11. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
Sub classification
Gender rule
upper appendicular skeleton
co-payment
12. The main term in the index may by followed by terms within parenthesis.
Compression fracture
Coinsurance
Alphabetic Index (Volume 2)
Modifiers
13. 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..
Parietal Bones
Past - family and social history (PFSH)
Musculoskeletal System
Maxilla
14. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Medicare
Category II Codes CPT
Employer Identification Number (EIN)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
15. 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.
History of present illness (HPI)
Gender rule
Performing Provider Identification Number (PPIN)
Full ROM
16. Is one who has no contract with the health insurance plan.
Accident
Nonparticipating physician
Lipocyte
Medicare Claim Status
17. Are conditions - situations - and services not covered by the insurance carrier.
Inferior nasal conchae
Unspecified (hypertension)
Exclusions and Limitations
ligaments
18. is a traumatic injury to a joint involving the soft tissue.
sprain
Relative Value Payment Schedules Method
Categorically needy -MEDICAID
TRICARE PLANS
19. Number assigned by the insurance company to a physician who renders services to patients.
Salter-Harris
Participating physician
Spinal/Vertebral Column
Provider Identification Number (PIN)
20. 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
The Current Procedural Terminology (CPT)
New Patient
Preferred Provider Organization (PPO)
Wheal
21. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
-26 - Professional Component
Vesicle
Surgical Package
22. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Sphenoid Bones
Parietal Bones
Contracted Rates with MCOs
Sections
23. 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.
Lacrimal bones
Dirty claim
Full ROM
Category I Codes CPT
24. 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.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Categories
Macule
Employer Liability
25. 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.
False ribs
The Integumentary System
Civil Monetary Penalties Law (CMPL)
Medicaid
26. The cuticle at the lower part of the nail and this is sometimes referred to as the
Comminuted fracture
eponychium
The St. Anthony Relative Value for Physicians (RVP)
Group Insurance
27. Typically not used on the claim form unless the provider does not have an EIN.
Malignant
Social Security Number
true ribs
Neoplasm Table
28. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Greenstick
Paper Claim
Outpatient
Full ROM
29. paired bones at the corner of each eye that cradle the tear ducts.
Lacrimal bones
Undetermined
Section 3 Index to External Causes of Injury (E codes)
Group practice
30. Produce secretions that allow the body to be moisturized or cooled.
Established Patient
Pre-authorization
sebaceous(oil) glands and the suddoriferous (sweat) glands
History
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
Unspecified (hypertension)
-99 - Multiple Modifiers
MEDICARE Part D
true ribs
32. 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.
Health practitioner
Disability insurance
nonessential modifiers
Subcategories
33. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
stand-alone codes
Group Insurance
encounter form
34. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
Health practitioner
Lacrimal bones
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
There are three layers to the skin
35. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
TRICARE
premium
stand-alone codes
Established Patient
36. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
co-payment
Provider Identification Number (PIN)
Qualified diagnosis
Health Insurance Portability and Accountability Act (HIPAA)
37. 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
Collagen
Peer Review Organization (PRO)
New Patient
Clearinghouse
38. 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.
Health Care Financing Administration Common Procedure Coding System
triangle (a
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Relative Value Payment Schedules Method
39. Noninvasive - non-spreading - nonmalignant
Reasons for Documentation
Medigap (Medicare Supplemental Insurance)
nonessential modifiers
Benign
40. 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
Rib Cage
Health Maintenance Organization (HMO)
Uncertain behavior
41. The moon like white area at the base of the nail.
Accept assignment
lunula
MEDICARE Part A
Performing Provider Identification Number (PPIN)
42. 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
stand-alone codes
Impetigo
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Capitated Rates
43. Groove or crack like sore
true ribs
Fissure
Salter-Harris
Two triangular symbols (a
44. death of tissue associated with loss of blood supply
Section 3 Index to External Causes of Injury (E codes)
Gangrene
Rejected claim
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
45. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Pelvis
Pubic bone
The Integumentary System
Point-of-Service plan (POS)
46. male of household is primary payer
Ulcermembranes
Gender rule
-50 - Bilateral Procedure
-26 - Professional Component
47. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Employer Identification Number (EIN)
phalanges (phalanx.s)
Zygoma
Personal Insurance
48. 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
A plus sign (+)
Workers Compensation
The Patient Care Partnership (Patient's Bill of Rights)
Group Provider Number
49. 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
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Consultation
Neoplasm Table
50. Benign growth extending from the surface of the mucous membrane
Carpals
Polyp
triangle (a
Pathologic