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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. 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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2. This is the inventory of the constitutional symptoms regarding the various body systems.
There are three layers to the skin
Alopecia
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Review of Systems (ROS)
3. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
lunula
-26 - Professional Component
Sesamoid bones
Impetigo
4. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Established patient
Birthday rule
Evaluation and Management Review
Temporal Bone
5. 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
Chapters
Accept assignment
Musculoskeletal System
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
6. Are conditions - situations - and services not covered by the insurance carrier.
Compression fracture
Primary malignancy
Exclusions and Limitations
Long bones
7. Groove or crack like sore
Fissure
Compression fracture
Medicare
HCPCS Level II codes (National Codes)
8. the bone is broken and the ends are driven into each other.
Blue Cross/Blue Shield Plans
Impacted
Category II Codes CPT
itemized statement
9. The fractured area of bone collapses on itself.
Dirty claim
Greenstick
encounter form
Compression fracture
10. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Chief complaint
Chief complaint (CC)
Alphabetic Index (Volume 2)
National Correct Coding Initiative (NCCI)
11. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Coinsurance
Invalid claim
Full ROM
upper appendicular skeleton
12. Pre-determined set of benefits covered under one set annual fee.
Occipital Bone
Pre-paid Health Plan
Workers Compensation
Keratin
13. Typically not used on the claim form unless the provider does not have an EIN.
Categories
Social Security Number
Hairline
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
14. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
The St. Anthony Relative Value for Physicians (RVP)
Undetermined
Gender rule
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
15. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Past - family and social history (PFSH)
Sesamoid bones
Fiscal Intermediary
Unspecified nature
16. 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)
Non-covered benefit
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
17. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Ethmoid Bone
Rib Cage
Parietal Bones
true ribs
18. A pregnant woman who has had at least one previous pregnancy.
circle with a line through it)
Health Insurance Portability and Accountability Act (HIPAA)
Lacrimal bones
Multigravida
19. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
-51 - Multiple Procedures
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Subcategories
20. uncertain whether benign or malignant; borderline malignancy
Unspecified (hypertension)
Sub classification
Ethmoid Bone
Uncertain behavior
21. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Medically needy
Carpals
Commercial Carriers
Unique Provider Identification Number (UPIN)
22. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Medicare Claim Status
Medicare
ulna
CPT SECTIONS.
23. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Fissure
-90 - Reference (Outside) Laboratory
Mandible
Multigravida
24. 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.
Medical necessity
Clean claim
Gangrene
Preferred Provider Organization (PPO)
25. 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
Deductible
Explanation of Benefits (EOB)
-32 - Mandated Services
26. is a traumatic injury to a joint involving the soft tissue.
Collagen
-51 - Multiple Procedures
sprain
Indemnity Insurance
27. Is one who has no contract with the health insurance plan.
Ulcermembranes
Chief complaint (CC)
Keratin
Nonparticipating physician
28. Deficient in pigment (melanin)
Polyp
Albino
phalanges (phalanx.s)
itemized statement
29. numbers 8-10 - are attached to the sternum by cartilage
Ulcermembranes
Macule
Humerus
False ribs
30. Produce secretions that allow the body to be moisturized or cooled.
Peer Review Organization (PRO)
Impacted
Evaluation and Management Review
sebaceous(oil) glands and the suddoriferous (sweat) glands
31. Mild or controlled hypertension and no damage to the vascular system or organs.
Carcinoma (Ca) in situ
Outpatient
Keratin
Benign (hypertension)
32. Represents a new procedure or service code added since the previous edition of the manual.
Keratin
bullet (a
Fee Schedule
Gender rule
33. 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
Lipocyte
Accident
HCPCS Level II codes (National Codes)
Inferior nasal conchae
34. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Group Provider Number
Secondary malignancy
Peer Review Organization (PRO)
Health Care Financing Administration Common Procedure Coding System
35. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
eponychium
true ribs
MEDICARE Part D
-50 - Bilateral Procedure
36. Is a working diagnosis which is not yet established.
Qualified diagnosis
Melanin
Unique Provider Identification Number (UPIN)
Primary malignancy
37. 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
co-payment
essential modifiers
Accident
Eligibility
38. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
False Claims Act (FCA)
Category III Codes CPT
Assault
encounter form
39. Is a working diagnosis which is not yet established.
Benign (hypertension)
Inpatient
Clearinghouse
Qualified diagnosis
40. Forms the sides of the cranium
Medicare Claim Status
Capitated Rates
There are two types of sweat glands
Parietal Bones
41. The lower anterior part of the bone
appendicular skeleton .
Sesamoid bones
Pubic bone
sebaceous(oil) glands and the suddoriferous (sweat) glands
42. male of household is primary payer
Peer Review Organization (PRO)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Gender rule
stand-alone codes
43. 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
Medicare Claim Status
Clearinghouse
Civil Monetary Penalties Law (CMPL)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
44. - 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.
Maxilla
Abuse
upper appendicular skeleton
Unauthorized benefit
45. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Temporal Bone
Tabular List (Volume 1)...
False Claims Act (FCA)
Category I Codes CPT
46. Number assigned by the insurance company to a physician who renders services to patients.
Fraud
Collagen
Provider Identification Number (PIN)
Tabular List (Volume 1)...
47. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
Undetermined
Birthday rule
Outpatient
essential modifiers
48. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)
Chief complaint (CC)
Remittance Advice
Hairline
co-payment
49. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Deductible
Category I Codes CPT
Palatine bones
Eligibility
50. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Modifiers
sprain
axial skeleton
The Current Procedural Terminology (CPT)