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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. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Keratin
Medicare
Pubic bone
Remittance Advice
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
Add-on codes
Inpatient
Employee Liability
Location Methods
3. 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
Inferior nasal conchae
Civil Monetary Penalties Law (CMPL)
Subcategories
Abuse
4. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
State License Number
-90 - Reference (Outside) Laboratory
Albino
5. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Macule
Health Maintenance Organization (HMO)
Fissure
Peer Review Organization (PRO)
6. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
Peer Review Organization (PRO)
MEDICARE Part D
Lacrimal bones
Outpatient
7. This is the inventory of the constitutional symptoms regarding the various body systems.
Full ROM
History
-51 - Multiple Procedures
Review of Systems (ROS)
8. open sore on the skin or mucous
Alphabetic Index (Volume 2)
Ulcermembranes
Gender rule
Keratin
9. 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
Relative Value Payment Schedules Method
Long bones
The Universal Claim Form
Sebaceous glands
10. 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
Medicare
Workers Compensation
Section 3 Index to External Causes of Injury (E codes)
Disability insurance
11. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
New patient
Employer Liability
Occipital Bone
Secondary malignancy
12. Absence of hair from areas where it normally grows
Alopecia
-51 - Multiple Procedures
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
-90 - Reference (Outside) Laboratory
13. The poisoning was self-inflicted.
Suicide Attempt
Macule
MEDICAID COVERAGE
The St. Anthony Relative Value for Physicians (RVP)
14. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Advance Beneficiary Notice
Social Security Number
Alopecia
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.
Carcinoma (Ca) in situ
Two triangular symbols (a
Add-on codes
There are three layers to the skin
16. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Fiscal Intermediary
Group Provider Number
There are two types of sweat glands
17. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
itemized statement
-99 - Multiple Modifiers
Long bones
Benign (hypertension)
18. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features
Lipocyte
Electronic Claim
Albino
Fee-for-Service
19. The cuticle at the lower part of the nail and this is sometimes referred to as the
MEDICAID COVERAGE
eponychium
Pre-authorization
Categorically needy -MEDICAID
20. 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
Established patient
Health Care Financing Administration Common Procedure Coding System
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Fee Schedule
21. most synarthroses are immovable joints held together by fibrous tissue.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
-90 - Reference (Outside) Laboratory
Medicare Claim Status
No ROM
22. Indicates add-on codes
-90 - Reference (Outside) Laboratory
-90 - Reference (Outside) Laboratory
A plus sign (+)
Personal Insurance
23. Superior and widest bone
Vomer
Pelvis
The Current Procedural Terminology (CPT)
phalanges (phalanx.s)
24. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
Pathologic
Retention of Medical Records
TRICARE PLANS
25. Number assigned to the physician by Medicare program.
Relative Value Payment Schedules Method
Unique Provider Identification Number (UPIN)
Coordination of Benefits (COB)
Consultation
26. Poisoning cannot be determined whether intentional or accidental.
Undetermined
The Good Samaritan Act
New Patient
Malignant
27. Pre-determined set of benefits covered under one set annual fee.
Fiscal Intermediary
Pre-certification
Pre-paid Health Plan
Abuse
28. 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.
Dirty claim
Physician
Hypertension Table
Health Maintenance Organization (HMO)
29. 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
Nonparticipating physician
Coordination of Benefits (COB)
Consultation
Surgical Package
30. 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
Coinsurance
Unlisted Procedures Procedures
Secondary malignancy
Non-covered benefit
31. Any fracture occurring spontaneously as a result of disease.
Pathologic
ligaments
Occipital Bone
History of present illness (HPI)
32. 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
Medical Records
-32 - Mandated Services
true ribs
Occipital Bone
33. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Unspecified nature
Subcategories
Medigap (Medicare Supplemental Insurance)
Category III Codes CPT
34. 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
The Integumentary System
Peer Review Organization (PRO)
History of present illness (HPI)
Sub classification
35. is a traumatic injury to a joint involving the soft tissue.
Performing Provider Identification Number (PPIN)
phalanges (phalanx.s)
sprain
-99 - Multiple Modifiers
36. Small collection of clear fluid;blister
Collagen
Vesicle
Spinal/Vertebral Column
Liability insurance
37. This modifier is used when the same procedure is performed on a mirror-image part of the body..
-50 - Bilateral Procedure
Health Insurance Portability and Accountability Act (HIPAA)
bullet (a
Carcinoma (Ca) in situ
38. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
Established patient
Modifiers
Surgical Package
Fee-for-Service
39. 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
Retention of Medical Records
The St. Anthony Relative Value for Physicians (RVP)
Albino
MEDICARE Part B
40. 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.
Explanation of Benefits (EOB)
Reasons for Documentation
Short bones
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
41. Noninvasive - non-spreading - nonmalignant
Benign
Section 3 Index to External Causes of Injury (E codes)
Medicare
lunula
42. 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
Sub classification
Remittance Advice
Complicated
Parietal Bones
43. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Tabular List (Volume 1)...
Review of Systems (ROS)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Malignant
44. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Abuse
essential modifiers
Coordination of Benefits (COB)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
45. 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
Electronic Claim
Comminuted fracture
Albino
Clearinghouse
46. 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.
Chief complaint (CC)
Accident
Group practice
Sesamoid bones
47. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
Birthday rule
ligaments
Deductible
Ethmoid Bone
48. 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
essential modifiers
Workers Compensation
-99 - Multiple Modifiers
Birthday rule
49. 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
MEDICARE Part D
Eligibility
Accept assignment
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
50. This is the inventory of the constitutional symptoms regarding the various body systems.
premium
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Employee Liability
Review of Systems (ROS)