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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. 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
Unspecified (hypertension)
encounter form
Full ROM
2. 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
Advance Beneficiary Notice
Clearinghouse
Medical necessity
Employee Liability
3. 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.
Add-on codes
Fiscal Intermediary
Lacrimal bones
Category II Codes CPT
4. is a traumatic injury to a joint involving the soft tissue.
Patient Confidentiality
New patient
Electronic Claim
sprain
5. represents Exemption from the use of modifier -51
circle with a line through it)
Hypertension Table
MEDICARE Part C
Ethmoid Bone
6. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
New patient
Sesamoid bones
Musculoskeletal System
Outpatient
7. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
There are three layers to the skin
There are two types of sweat glands
Spinal/Vertebral Column
encounter form
8. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Add-on codes
Ulcermembranes
Flat bones
Patient Confidentiality
9. 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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10. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Full ROM
Impetigo
Participating physician
11. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Patient Confidentiality
axial skeleton
Deductible
12. Forms the anterior part of the skull and the forehead
Rejected claim
Frontal Bone
Capitated Rates
Fraud
13. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
MEDICARE Part C
Impacted
Tabular List (Volume 1)...
14. 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.
Health Insurance Portability and Accountability Act (HIPAA)
phalanges (phalanx.s)
TRICARE PLANS
Complicated
15. 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
Section 3 Index to External Causes of Injury (E codes)
-99 - Multiple Modifiers
The Current Procedural Terminology (CPT)
16. 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:
triangle (a
Tabular List (Volume 1)...
Hypertension Table
Fee-for-Service
17. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Long bones
Add-on codes
TRICARE PLANS
-50 - Bilateral Procedure
18. numbers 8-10 - are attached to the sternum by cartilage
nonessential modifiers
False ribs
Pre-determination
New Patient
19. is a traumatic injury to a joint involving the soft tissue.
sprain
Suicide Attempt
phalanges (phalanx.s)
Salter-Harris
20. The fractured area of bone collapses on itself.
Compression fracture
Lacrimal bones
Full ROM
Ulcermembranes
21. Is an electronic or paper-based report of payment sent by the payer to the provider.
Indemnity Insurance
Remittance Advice
Macule
Clean claim
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.
MEDICARE Part B
Capitated Rates
Unauthorized benefit
Albino
23. Forms the sides of the cranium
Parietal Bones
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Point-of-Service plan (POS)
Sesamoid bones
24. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Primary malignancy
MEDICARE Part C
Pre-determination
25.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Rejected claim
Wheal
Medically needy
26. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu
Blue Cross/Blue Shield Plans
Malignant
Inferior nasal conchae
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
27. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Clean claim
Group Insurance
Sub classification
Pre-paid Health Plan
28. 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
State License Number
Chief complaint (CC)
Birthday rule
29. 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.
Medicaid
Civil Monetary Penalties Law (CMPL)
Indemnity Insurance
Pre-determination
30. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Compression fracture
Contracted Rates with MCOs
Polyp
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
31. The fractured area of bone collapses on itself.
axial skeleton
Compression fracture
Limited ROM
Flat bones
32. 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.
Evaluation and Management Review
Category II Codes CPT
MEDICARE Part A
Add-on codes
33. A fat cell
Inpatient
Gangrene
Lipocyte
-32 - Mandated Services
34. 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
Abuse
Blue Cross/Blue Shield Plans
Complicated
itemized statement
35. 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
Mandible
Workers Compensation
Consultation
Malignant
36. 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
Capitated Rates
Chapters
MEDICARE Part D
sprain
37. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Personal Insurance
A plus sign (+)
Sesamoid bones
38. The moon like white area at the base of the nail.
Limited ROM
lunula
Provider Identification Number (PIN)
TRICARE
39. Is the qualifying factor or factors that must be met before a patient receives benefits.
Malignant
Eligibility
Add-on codes
Sphenoid Bones
40. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
-32 - Mandated Services
Macule
Lacrimal bones
Sesamoid bones
41. The main term in the index may by followed by terms within parenthesis.
Alphabetic Index (Volume 2)
Malignant
The Integumentary System
HCPCS Level I codes
42. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Established patient
Temporal Bone
Full ROM
Medicaid
43. are small with irregular shapes. They are found in the wrist and ankle.
The Universal Claim Form
Preferred Provider plan
Short bones
Impetigo
44. 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
Long bones
Preferred Provider Organization (PPO)
Contracted Rates with MCOs
Evaluation and Management Review
45. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Category I Codes CPT
Complicated
CPT SECTIONS.
-90 - Reference (Outside) Laboratory
46. 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.
Medical Records
Invalid claim
Group practice
itemized statement
47. most synarthroses are immovable joints held together by fibrous tissue.
Ulcermembranes
No ROM
Zygoma
Impetigo
48. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Provider Identification Number (PIN)
Sesamoid bones
bullet (a
Mutually Exclusive Edits
49. 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 -
Deductible
Greenstick
Clean claim
Indemnity Insurance
50. 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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