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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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 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.
Established Patient
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Medicare Claim Status
TRICARE PLANS
2. requires investigation and needs further clarification.
Category I Codes CPT
Modifiers
Rejected claim
Zygoma
3. forms the two lower sides of the cranium.
Evaluation and Management Review
Temporal Bone
Ulcermembranes
Inpatient
4. solid - round or oval elevated lesion more than 1 cm in diameter
lunula
Nodule
Established patient
Health Insurance Portability and Accountability Act (HIPAA)
5. The cuticle at the lower part of the nail and this is sometimes referred to as the
Medigap (Medicare Supplemental Insurance)
eponychium
Disability insurance
Medicare
6. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Category II Codes CPT
Ethmoid Bone
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Carcinoma (Ca) in situ
7. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
False Claims Act (FCA)
Medigap (Medicare Supplemental Insurance)
Carpals
Carcinoma (Ca) in situ
8. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
phalanges (phalanx.s)
Personal Insurance
National Correct Coding Initiative (NCCI)
9. .. lower jaw bone.
Explanation of Benefits (EOB)
Mandible
The Integumentary System
Qualified diagnosis
10. male of household is primary payer
Pre-authorization
Carcinoma (Ca) in situ
Gender rule
Health Insurance Portability and Accountability Act (HIPAA)
11. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Medicaid
Temporal Bone
Chapters
HCPCS Level I codes
12. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Provider Identification Number (PIN)
Qualified diagnosis
Nodule
13. '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
Category III Codes CPT
Non-covered benefit
HCPCS Level I codes
Employee Liability
14. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Suicide Attempt
Fee-for-Service
Accept assignment
Category II Codes CPT
15. 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.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Secondary malignancy
Blue Cross/Blue Shield Plans
Clean claim
16. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
lunula
TRICARE
The Good Samaritan Act
Medicare
17. 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
MEDICARE Part D
Health Maintenance Organization (HMO)
Limited ROM
Musculoskeletal System
18. 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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19. 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
Rib Cage
Albino
Fee Schedule
stand-alone codes
20. 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
Two triangular symbols (a
MEDICARE Part D
History
appendicular skeleton .
21. 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
Pre-authorization
The St. Anthony Relative Value for Physicians (RVP)
Melanin
22. forms the roof of the nasal cavity.
Ethmoid Bone
Unspecified nature
Modifiers
Group practice
23. 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
Full ROM
circle with a line through it)
Health Maintenance Organization (HMO)
24. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
Coinsurance
Pre-determination
MEDICAID COVERAGE
Benign (hypertension)
25. Pre-determined set of benefits covered under one set annual fee.
Alopecia
Pre-paid Health Plan
Hairline
Limited ROM
26. 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.
Benign (hypertension)
appendicular skeleton .
Compliance Regulations
Modifiers
27. 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.
HCPCS Level II codes (National Codes)
ligaments
National Correct Coding Initiative (NCCI)
Pathologic
28. 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
phalanges (phalanx.s)
Health practitioner
Surgical Package
Capitated Rates
29. the bone is crushed and or shattered.
Eligibility
Neoplasm Table
Unspecified nature
Comminuted fracture
30. 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
False ribs
Clean claim
Category I Codes CPT
Abuse
31. .. lower jaw bone.
Remittance Advice
Compliance Regulations
Mandible
Medicaid
32. 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:
Hypertension Table
Frontal Bone
Short bones
The Integumentary System
33. Is an electronic or paper-based report of payment sent by the payer to the provider.
Remittance Advice
Radius
Sebaceous glands
Chief complaint
34. 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
Exclusions and Limitations
Lipocyte
Medicare
Inferior nasal conchae
35. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Wheal
Colles
Personal Insurance
Mutually Exclusive Edits
36. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Impetigo
Medical necessity
Multigravida
Primary malignancy
37. 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
Inpatient
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Add-on codes
38. 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.
Keratin
Dirty claim
Personal Insurance
Deductible
39. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Lipocyte
Paper Claim
Add-on codes
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
40. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Long bones
Sub classification
Participating physician
TRICARE
41. Produce secretions that allow the body to be moisturized or cooled.
Compliance Regulations
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Qualified diagnosis
sebaceous(oil) glands and the suddoriferous (sweat) glands
42. Is an electronic or paper-based report of payment sent by the payer to the provider.
Medical necessity
-32 - Mandated Services
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Remittance Advice
43. uncertain whether benign or malignant; borderline malignancy
Relative Value Payment Schedules Method
Uncertain behavior
Impetigo
Location Methods
44. Is when two insurance companies work together to coordinate payment of the benefits.
Categorically needy -MEDICAID
Unspecified nature
Polyp
Coordination of Benefits (COB)
45. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Musculoskeletal System
Remittance Advice
encounter form
History
46. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Fraud
Established Patient
Employer Identification Number (EIN)
Temporal Bone
47. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
There are three layers to the skin
Categories
-50 - Bilateral Procedure
No ROM
48. 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
Explanation of Benefits (EOB)
Categories
Wheal
The Integumentary System
49. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
No ROM
Carpals
Personal Insurance
Location Methods
50. 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
Nonparticipating physician
stand-alone codes
true ribs
Health practitioner