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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Frontal Bone
Pelvis
Mandible
2. poisoning was inflicted by another person with intent to kill or injure
Carcinoma (Ca) in situ
Frontal Bone
Assault
Long bones
3. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Hypertension Table
Sebaceous glands
State License Number
Compression fracture
4. 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
Exclusions and Limitations
Clearinghouse
Complicated
MEDICARE Part D
5. 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
Spinal/Vertebral Column
Preferred Provider plan
Outpatient
Electronic Claim
6. 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....
Humerus
stand-alone codes
The St. Anthony Relative Value for Physicians (RVP)
Sebaceous glands
7. The bone is broken and pierces an internal organ
Nonparticipating physician
Macule
Complicated
Vomer
8. Superior and widest bone
Pelvis
Mutually Exclusive Edits
Category II Codes CPT
TRICARE
9. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
Employer Liability
phalanges (phalanx.s)
Two triangular symbols (a
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
10. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Liability insurance
Colles
Long bones
Carcinoma (Ca) in situ
11. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Vomer
Reasons for Documentation
Pre-paid Health Plan
Medicare
12. '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
-32 - Mandated Services
Pubic bone
premium
Employee Liability
13. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Maxilla
Rib Cage
Primary malignancy
Birthday rule
14. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Category I Codes CPT
Polyp
Medically needy
Colles
15. solid - round or oval elevated lesion more than 1 cm in diameter
Indemnity Insurance
Categorically needy -MEDICAID
Colles
Nodule
16. anterior to the temporal bones.
Radius
Gender rule
Sphenoid Bones
co-payment
17. 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.
Frontal Bone
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Advance Beneficiary Notice
Maxilla
18. 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.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
MEDICARE Part B
Undetermined
Physician
19. 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.
Group Provider Number
Performing Provider Identification Number (PPIN)
Salter-Harris
Birthday rule
20. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Electronic Claim
Medicare
Malignant
-26 - Professional Component
21. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
circle with a line through it)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Reasons for Documentation
-90 - Reference (Outside) Laboratory
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
Pelvis
Unique Provider Identification Number (UPIN)
Point-of-Service plan (POS)
Past - family and social history (PFSH)
23. 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
Chief complaint (CC)
Unspecified nature
MEDICARE Part C
Preferred Provider Organization (PPO)
24. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
Categories
The Integumentary System
Social Security Number
25. 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.
New patient
Pre-paid Health Plan
Workers Compensation
Categorically needy -MEDICAID
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
Suicide Attempt
Blue Cross/Blue Shield Plans
Gender rule
Relative Value Payment Schedules Method
27. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Performing Provider Identification Number (PPIN)
Invalid claim
The Good Samaritan Act
Multigravida
28. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Musculoskeletal System
Coding
-26 - Professional Component
Invalid claim
29. 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.
Preferred Provider Organization (PPO)
Exclusions and Limitations
Flat bones
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
30. 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
Electronic Claim
Occipital Bone
sebaceous(oil) glands and the suddoriferous (sweat) glands
Group practice
31. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Category I Codes CPT
Inpatient
Modifiers
TRICARE PLANS
32. Typically not used on the claim form unless the provider does not have an EIN.
Review of Systems (ROS)
Social Security Number
Electronic Claim
Rib Cage
33. is defined as one who has not received any medical services within the last three years.
New Patient
MEDICARE Part B
Ulcermembranes
Occipital Bone
34. .. lower jaw bone.
New patient
Mandible
Impetigo
Health practitioner
35. This is the inventory of the constitutional symptoms regarding the various body systems.
Colles
Review of Systems (ROS)
Maxilla
Peer Review Organization (PRO)
36. Number assigned by the insurance company to a physician who renders services to patients.
The Universal Claim Form
Comminuted fracture
Provider Identification Number (PIN)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
37. 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.
Secondary malignancy
National Correct Coding Initiative (NCCI)
Dirty claim
Review of Systems (ROS)
38. 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.
Impacted
Impacted
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Accept assignment
39. 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
The Current Procedural Terminology (CPT)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
MEDICARE Part D
Benign (hypertension)
40. 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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41. 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
Accident
Commercial Carriers
Humerus
Assault
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
sebaceous(oil) glands and the suddoriferous (sweat) glands
Medigap (Medicare Supplemental Insurance)
Medicare Claim Status
43. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Peer Review Organization (PRO)
Medical necessity
Gender rule
Paper Claim
44. 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
Indemnity Insurance
Qualified diagnosis
Lipocyte
45. 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
Fee Schedule
Rejected claim
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Long bones
46. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Rib Cage
Health Insurance Portability and Accountability Act (HIPAA)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Temporal Bone
47. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Greenstick
Carcinoma (Ca) in situ
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Pelvis
48. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
Temporal Bone
Chief complaint (CC)
Alopecia
CPT SECTIONS.
49. 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
Sebaceous glands
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
TRICARE PLANS
Medicaid
50. 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.
-32 - Mandated Services
Social Security Number
Compression fracture
The Integumentary System