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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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Match each statement with the correct term.
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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. Is the lower medial arm bone.
Medicare Claim Status
Compression fracture
ulna
Subcategories
3. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
lunula
Add-on codes
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Employer Liability
4. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
The St. Anthony Relative Value for Physicians (RVP)
Melanin
axial skeleton
5. 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
Coinsurance
Employee Liability
Unlisted Procedures Procedures
6. 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
Group practice
The Current Procedural Terminology (CPT)
There are three layers to the skin
A plus sign (+)
7. Make up part of the interior of the nose.
Retention of Medical Records
Inferior nasal conchae
Malignant
Peer Review Organization (PRO)
8. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Zygoma
Uncertain behavior
Preferred Provider Organization (PPO)
9. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Medigap (Medicare Supplemental Insurance)
Benign
Deductible
Melanin
10. 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
Flat bones
Frontal Bone
HCPCS Level II codes (National Codes)
Unique Provider Identification Number (UPIN)
11. The physician must obtain this number in order to practice within a state.
Frontal Bone
State License Number
Fraud
Established patient
12. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
HCPCS Level I codes
Complicated
Add-on codes
Category III Codes CPT
13. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Long bones
Alopecia
Alphabetic Index (Volume 2)
Group Provider Number
14. open sore on the skin or mucous
Civil Monetary Penalties Law (CMPL)
Ulcermembranes
Suicide Attempt
Benign
15. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
phalanges (phalanx.s)
bullet (a
lunula
Hairline
16. 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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17. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Invalid claim
Carpals
axial skeleton
New patient
18. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
phalanges (phalanx.s)
Employer Identification Number (EIN)
Chief complaint
axial skeleton
19. 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
Fee-for-Service
Nodule
Fiscal Intermediary
Capitated Rates
20. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Health Insurance Portability and Accountability Act (HIPAA)
State License Number
No ROM
Group practice
21. 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....
Fraud
Medicare Claim Status
The St. Anthony Relative Value for Physicians (RVP)
Health Insurance Portability and Accountability Act (HIPAA)
22. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Past - family and social history (PFSH)
lunula
Unlisted Procedures Procedures
Unspecified nature
23. 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.
State License Number
Wheal
Health Insurance Portability and Accountability Act (HIPAA)
Pre-determination
24. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Long bones
Fissure
MEDICARE Part A
Chief complaint (CC)
25. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Ulcermembranes
Preferred Provider Organization (PPO)
Personal Insurance
Spinal/Vertebral Column
26. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.
Unauthorized benefit
triangle (a
Collagen
Short bones
27. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
-90 - Reference (Outside) Laboratory
Modifiers
upper appendicular skeleton
Chapters
28. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Malignant
-26 - Professional Component
Sesamoid bones
Greenstick
29. the bone is crushed and or shattered.
Hairline
There are two types of sweat glands
Undetermined
Comminuted fracture
30. Are composed of three-digit codes representing a single disease or condition.
Categories
phalanges (phalanx.s)
sebaceous(oil) glands and the suddoriferous (sweat) glands
The Good Samaritan Act
31. forms the roof of the nasal cavity.
Preferred Provider plan
Ethmoid Bone
New Patient
Compliance Regulations
32. This is not specified as benign or malignant in the diagnosis or medical record.
Section 3 Index to External Causes of Injury (E codes)
Sebaceous glands
Unspecified (hypertension)
appendicular skeleton .
33. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
Occipital Bone
Add-on codes
Group practice
MEDICARE Part A
34. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Temporal Bone
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Participating physician
35. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Benign
-90 - Reference (Outside) Laboratory
Peer Review Organization (PRO)
Unspecified (hypertension)
36. 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.
Eligibility
Vomer
eponychium
phalanges (phalanx.s)
37. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Add-on codes
Accept assignment
TRICARE
Group Provider Number
38. Is a working diagnosis which is not yet established.
Musculoskeletal System
Qualified diagnosis
Collagen
Malignant
39. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Vomer
Medical Records
Category I Codes CPT
-26 - Professional Component
40. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
Evaluation and Management Review
Health Care Financing Administration Common Procedure Coding System
Birthday rule
Chapters
41. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
eponychium
Fissure
Categories
42. Are conditions - situations - and services not covered by the insurance carrier.
Vesicle
Exclusions and Limitations
Coordination of Benefits (COB)
Physician
43. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Uncertain behavior
Preferred Provider Organization (PPO)
Indemnity Insurance
There are two types of sweat glands
44. Describes the services billed and includes a breakdown of how the payment is determined
Civil Monetary Penalties Law (CMPL)
Explanation of Benefits (EOB)
MEDICAID COVERAGE
Long bones
45. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H
TRICARE
Provider Identification Number (PIN)
sebaceous(oil) glands and the suddoriferous (sweat) glands
Suicide Attempt
46. The lower anterior part of the bone
Pubic bone
Fee-for-Service
Sebaceous glands
-51 - Multiple Procedures
47. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Performing Provider Identification Number (PPIN)
Pelvis
sebaceous(oil) glands and the suddoriferous (sweat) glands
Impetigo
48. Is made up of the shoulder - collar - pelvic and arms and legs
Melanin
co-payment
appendicular skeleton .
Birthday rule
49. The moon like white area at the base of the nail.
-26 - Professional Component
lunula
MEDICARE Part A
Point-of-Service plan (POS)
50. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Rejected claim
TRICARE PLANS
Coinsurance
Contracted Rates with MCOs
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