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Test your basic knowledge |
Medical Billing And Coding Vocab
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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. 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.
MEDICARE Part C
Category II Codes CPT
Categories
Established Patient
2. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual
Fee Schedule
premium
Employer Identification Number (EIN)
Established patient
3. 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.
Inpatient
Employer Liability
TRICARE
Dirty claim
4. 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
Colles
Capitated Rates
Colles
essential modifiers
5. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
Hairline
Remittance Advice
Benign
6. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
phalanges (phalanx.s)
Disability insurance
Gangrene
Consultation
7. death of tissue associated with loss of blood supply
triangle (a
Gangrene
Impetigo
Polyp
8. 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.
Consultation
The Universal Claim Form
Contracted Rates with MCOs
National Correct Coding Initiative (NCCI)
9. 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
Palatine bones
Group practice
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Impacted
10. 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
Modifiers
Non-covered benefit
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
MEDICARE Part B
11. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
The St. Anthony Relative Value for Physicians (RVP)
Chief complaint
Greenstick
12. Groove or crack like sore
Pre-paid Health Plan
Fissure
Nonparticipating physician
Paper Claim
13. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
The Universal Claim Form
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Unspecified nature
Category III Codes CPT
14. The lower anterior part of the bone
Zygoma
Invalid claim
Established Patient
Pubic bone
15. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
Peer Review Organization (PRO)
Two triangular symbols (a
Fee-for-Service
Employee Liability
16. .. lower jaw bone.
upper appendicular skeleton
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Mandible
Keratin
17. anterior to the temporal bones.
phalanges (phalanx.s)
Pre-paid Health Plan
Unauthorized benefit
Sphenoid Bones
18. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Accident
-26 - Professional Component
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
19. 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)
ligaments
Fee Schedule
History
20. 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
Inpatient
Pubic bone
Relative Value Payment Schedules Method
Fiscal Intermediary
21. make up part of the roof of the mouth
upper appendicular skeleton
Palatine bones
Fiscal Intermediary
Health Care Financing Administration Common Procedure Coding System
22. Are conditions - situations - and services not covered by the insurance carrier.
Mandible
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Exclusions and Limitations
Pre-certification
23. Is the lateral lower arm bone (in line with the thumb).
Macule
New Patient
Radius
Inferior nasal conchae
24. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Category I Codes CPT
Ulcermembranes
Deductible
The Good Samaritan Act
25. 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
Secondary malignancy
Fee-for-Service
Medicare
appendicular skeleton .
26. Consists of the skull - rib cage - and spine
axial skeleton
Health Insurance Portability and Accountability Act (HIPAA)
Pre-authorization
Undetermined
27. 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
Pre-determination
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Sebaceous glands
Deductible
28. 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
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Medical Records
Multigravida
29. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
MEDICARE Part C
Chief complaint (CC)
MEDICARE Part B
Disability insurance
30. Indicates add-on codes
A plus sign (+)
Compliance Regulations
Group Insurance
Performing Provider Identification Number (PPIN)
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
-99 - Multiple Modifiers
Limited ROM
Palatine bones
Medical necessity
32. 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.
Electronic Claim
Primary malignancy
Medicaid
Participating physician
33. are small with irregular shapes. They are found in the wrist and ankle.
Categorically needy -MEDICAID
Chief complaint (CC)
Short bones
The Universal Claim Form
34. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Health Insurance Portability and Accountability Act (HIPAA)
Provider Identification Number (PIN)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
35. 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.
Pre-paid Health Plan
Fraud
Eligibility
National Correct Coding Initiative (NCCI)
36. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Greenstick
New Patient
Employer Liability
phalanges (phalanx.s)
37. The poisoning was self-inflicted.
Unique Provider Identification Number (UPIN)
Civil Monetary Penalties Law (CMPL)
The Current Procedural Terminology (CPT)
Suicide Attempt
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
Retention of Medical Records
Abuse
Wheal
Deductible
39. Structural protein found in the skin and connective tissue
essential modifiers
Categories
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Collagen
40. The main term in the index may by followed by terms within parenthesis.
Employer Liability
The Universal Claim Form
Mutually Exclusive Edits
Alphabetic Index (Volume 2)
41. requires investigation and needs further clarification.
Rejected claim
Pathologic
Performing Provider Identification Number (PPIN)
-51 - Multiple Procedures
42. 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
Indemnity Insurance
sprain
Categorically needy -MEDICAID
Alopecia
43. represents Exemption from the use of modifier -51
Carpals
circle with a line through it)
Medigap (Medicare Supplemental Insurance)
Pre-authorization
44. Is the upper arm bone.
Polyp
Health practitioner
circle with a line through it)
Humerus
45. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
-90 - Reference (Outside) Laboratory
Alopecia
Group Provider Number
Location Methods
46. 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
Health Maintenance Organization (HMO)
Birthday rule
Sections
Parietal Bones
47. .. lower jaw bone.
Advance Beneficiary Notice
Mandible
Category I Codes CPT
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
48. The main term in the index may by followed by terms within parenthesis.
Alphabetic Index (Volume 2)
Modifiers
Abuse
Vesicle
49. 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
Provider Identification Number (PIN)
Nodule
Neoplasm Table
Mandible
50. are small with irregular shapes. They are found in the wrist and ankle.
Short bones
Disability insurance
Benign
Primary malignancy