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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.
If you are not ready to take this test, you can
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. Structural protein found in the skin and connective tissue
Salter-Harris
Parietal Bones
Collagen
Group Insurance
2. '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
Employee Liability
ligaments
Fraud
Complicated
3. Any fracture occurring spontaneously as a result of disease.
Carpals
Pathologic
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
triangle (a
4. The main term in the index may by followed by terms within parenthesis.
Inferior nasal conchae
Alphabetic Index (Volume 2)
Accept assignment
Melanin
5. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
-90 - Reference (Outside) Laboratory
Primary malignancy
The St. Anthony Relative Value for Physicians (RVP)
6. 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.
appendicular skeleton .
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Gender rule
Category II Codes CPT
7. death of tissue associated with loss of blood supply
Compression fracture
There are three layers to the skin
Uncertain behavior
Gangrene
8. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Wheal
Health Care Financing Administration Common Procedure Coding System
Accident
Review of Systems (ROS)
9. Describes the services billed and includes a breakdown of how the payment is determined
Fraud
State License Number
Coding
Explanation of Benefits (EOB)
10. 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
Mutually Exclusive Edits
Hypertension Table
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Frontal Bone
11. 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.
Advance Beneficiary Notice
Dirty claim
Nodule
Relative Value Payment Schedules Method
12. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
Unspecified (hypertension)
Modifiers
itemized statement
bullet (a
13. 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.
Accept assignment
Albino
encounter form
Pre-determination
14. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Coinsurance
Primary malignancy
Salter-Harris
Sphenoid Bones
15. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Sesamoid bones
Malignant
Vomer
-50 - Bilateral Procedure
16. 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
Nonparticipating physician
Wheal
Commercial Carriers
Section 3 Index to External Causes of Injury (E codes)
17. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
National Correct Coding Initiative (NCCI)
Coding
Tabular List (Volume 1)...
-26 - Professional Component
18. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
Chief complaint
Sub classification
Preferred Provider Organization (PPO)
Non-covered benefit
19. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Medicare
Full ROM
Nonparticipating physician
Flat bones
20. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
History of present illness (HPI)
Lipocyte
MEDICARE Part B
Clearinghouse
21. Is when two insurance companies work together to coordinate payment of the benefits.
Humerus
Coordination of Benefits (COB)
CPT SECTIONS.
HCPCS Level I codes
22. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Frontal Bone
Subcategories
Pubic bone
Long bones
23. Contains complete - necessary information - but is incorrect or illogical in some way.
Review of Systems (ROS)
Invalid claim
New Patient
-51 - Multiple Procedures
24. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Uncertain behavior
The Universal Claim Form
The Good Samaritan Act
Clean claim
25. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.
Physician
Provider Identification Number (PIN)
HCPCS Level I codes
Parietal Bones
26. 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
circle with a line through it)
Clearinghouse
Outpatient
Ulcermembranes
27. 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
Explanation of Benefits (EOB)
The Current Procedural Terminology (CPT)
MEDICARE Part A
Ulcermembranes
28. Discolored - flat lesion (freckles - tattoo marks)
Macule
Outpatient
Secondary malignancy
appendicular skeleton .
29. 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.
Pre-certification
Hypertension Table
Inpatient
Chief complaint (CC)
30. 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
Pelvis
Clearinghouse
Established patient
A plus sign (+)
31. make up part of the roof of the mouth
Assault
Fiscal Intermediary
Palatine bones
Coinsurance
32. 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
Dirty claim
Albino
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
33. 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.
encounter form
Preferred Provider plan
Neoplasm Table
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
34. Is the qualifying factor or factors that must be met before a patient receives benefits.
HCPCS Level II codes (National Codes)
Eligibility
Ulcermembranes
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
35. Number assigned to the physician by Medicare program.
Remittance Advice
Physician
Performing Provider Identification Number (PPIN)
Unique Provider Identification Number (UPIN)
36. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
sprain
Musculoskeletal System
Mutually Exclusive Edits
Ulcermembranes
37. 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.
Add-on codes
Established patient
Lipocyte
No ROM
38. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
Modifiers
MEDICARE Part B
Reasons for Documentation
The Universal Claim Form
39. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
-32 - Mandated Services
nonessential modifiers
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
40. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Nodule
Add-on codes
Category I Codes CPT
Column 1/Column 2 (previously called Comprehensive/Component) Edits
41. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Pubic bone
sebaceous(oil) glands and the suddoriferous (sweat) glands
Gender rule
Coding
42. Lower portion of the pelvic bone
Remittance Advice
Ischium
appendicular skeleton .
The Current Procedural Terminology (CPT)
43. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Unauthorized benefit
Categorically needy -MEDICAID
Rib Cage
The Good Samaritan Act
44. Pre-determined set of benefits covered under one set annual fee.
Accident
Impetigo
Clearinghouse
Pre-paid Health Plan
45. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi
Pre-authorization
Full ROM
Health Maintenance Organization (HMO)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
46. .. lower jaw bone.
Medical Records
Mandible
Pathologic
Health Maintenance Organization (HMO)
47. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Unlisted Procedures Procedures
Modifiers
Compression fracture
Column 1/Column 2 (previously called Comprehensive/Component) Edits
48. male of household is primary payer
Gender rule
Tabular List (Volume 1)...
Add-on codes
Maxilla
49. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Abuse
Musculoskeletal System
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Full ROM
50. is defined as one who has not received any medical services within the last three years.
New Patient
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Preferred Provider plan
Contracted Rates with MCOs