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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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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. open sore on the skin or mucous
Relative Value Payment Schedules Method
Benign
Medicaid
Ulcermembranes
2. Mild or controlled hypertension and no damage to the vascular system or organs.
Health Care Financing Administration Common Procedure Coding System
Category I Codes CPT
Benign (hypertension)
axial skeleton
3. Benign growth extending from the surface of the mucous membrane
Hypertension Table
Polyp
Comminuted fracture
The Universal Claim Form
4. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Commercial Carriers
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
MEDICAID COVERAGE
Unspecified nature
5. 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.
Collagen
sebaceous(oil) glands and the suddoriferous (sweat) glands
itemized statement
Sub classification
6. 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
Pre-certification
-51 - Multiple Procedures
lunula
The Universal Claim Form
7. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Evaluation and Management Review
Location Methods
Indemnity Insurance
Explanation of Benefits (EOB)
8. 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
-32 - Mandated Services
Gender rule
Ethmoid Bone
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
Medigap (Medicare Supplemental Insurance)
Explanation of Benefits (EOB)
Polyp
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
10. 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.
Non-covered benefit
Malignant
upper appendicular skeleton
Relative Value Payment Schedules Method
11. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
Disability insurance
Review of Systems (ROS)
Clean claim
Employee Liability
12. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Dirty claim
MEDICARE Part C
Mandible
Secondary malignancy
13. 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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14. The lower anterior part of the bone
Pubic bone
Undetermined
Location Methods
Maxilla
15. Represents a new procedure or service code added since the previous edition of the manual.
Radius
Fissure
essential modifiers
bullet (a
16. 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.
nonessential modifiers
Outpatient
Evaluation and Management Review
Clean claim
17. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.
Impetigo
Compliance Regulations
Unlisted Procedures Procedures
Pre-authorization
18. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -
Coding
Provider Identification Number (PIN)
Blue Cross/Blue Shield Plans
essential modifiers
19. Number assigned to the physician by Medicare program.
Short bones
Preferred Provider plan
Unique Provider Identification Number (UPIN)
The St. Anthony Relative Value for Physicians (RVP)
20. Forms the anterior part of the skull and the forehead
-32 - Mandated Services
Undetermined
Frontal Bone
The Current Procedural Terminology (CPT)
21. is a traumatic injury to a joint involving the soft tissue.
sprain
Commercial Carriers
-99 - Multiple Modifiers
Chapters
22. - 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.
The St. Anthony Relative Value for Physicians (RVP)
Ulcermembranes
Sesamoid bones
Unauthorized benefit
23. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Indemnity Insurance
Performing Provider Identification Number (PPIN)
Medical Records
Gender rule
24. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
ligaments
HCPCS Level I codes
Compression fracture
Radius
25. major skin pigment
-99 - Multiple Modifiers
The St. Anthony Relative Value for Physicians (RVP)
Melanin
CPT SECTIONS.
26. 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
Melanin
Parietal Bones
Health Care Financing Administration Common Procedure Coding System
The Universal Claim Form
27. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Abuse
MEDICAID COVERAGE
Vomer
28. Is the upper arm bone.
Full ROM
Humerus
Category II Codes CPT
Vomer
29. Upper jaw bone
Section 3 Index to External Causes of Injury (E codes)
MEDICARE Part B
The Good Samaritan Act
Maxilla
30. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
CPT SECTIONS.
HCPCS Level II codes (National Codes)
Surgical Package
co-payment
31. 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
Evaluation and Management Review
Invalid claim
Established patient
Fee Schedule
32. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Alphabetic Index (Volume 2)
-50 - Bilateral Procedure
Pre-determination
Accept assignment
33. 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
History
Group Provider Number
The Current Procedural Terminology (CPT)
Greenstick
34. 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
Zygoma
There are three layers to the skin
Reasons for Documentation
Consultation
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
Vomer
MEDICARE Part D
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Inferior nasal conchae
36. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Category III Codes CPT
37. 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)
eponychium
Lipocyte
co-payment
TRICARE PLANS
38. 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.
Unspecified (hypertension)
Medicare Claim Status
Tabular List (Volume 1)...
phalanges (phalanx.s)
39. 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
Unspecified (hypertension)
Mandible
MEDICARE Part D
Group Insurance
40. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
Group Provider Number
-32 - Mandated Services
Flat bones
HCPCS Level II codes (National Codes)
41. 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
Benign
Clearinghouse
Multigravida
Subcategories
42. The moon like white area at the base of the nail.
lunula
Uncertain behavior
Lacrimal bones
Eligibility
43. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
Category II Codes CPT
sprain
Established Patient
Patient Confidentiality
44. 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
HCPCS Level I codes
Malignant
Accident
-32 - Mandated Services
45. A pregnant woman who has had at least one previous pregnancy.
Reasons for Documentation
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Multigravida
There are three layers to the skin
46. Number assigned to the physician by Medicare program.
Unique Provider Identification Number (UPIN)
Provider Identification Number (PIN)
Carcinoma (Ca) in situ
Subcategories
47. 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
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
-51 - Multiple Procedures
No ROM
Malignant
48. uncertain whether benign or malignant; borderline malignancy
False Claims Act (FCA)
Uncertain behavior
New patient
Medically needy
49. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
Preferred Provider Organization (PPO)
Relative Value Payment Schedules Method
History
Qualified diagnosis
50. forms the two lower sides of the cranium.
Benign (hypertension)
Temporal Bone
Indemnity Insurance
Capitated Rates