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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.
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. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
There are three layers to the skin
Temporal Bone
Sesamoid bones
Indemnity Insurance
2. Structural protein found in the skin and connective tissue
Colles
Employee Liability
Collagen
TRICARE PLANS
3. forms the two lower sides of the cranium.
Nonparticipating physician
Temporal Bone
Medicaid
Pubic bone
4. 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'.
bullet (a
Full ROM
Pre-authorization
Undetermined
5. Is one who has no contract with the health insurance plan.
-50 - Bilateral Procedure
Nonparticipating physician
New Patient
Nodule
6. This is the inventory of the constitutional symptoms regarding the various body systems.
true ribs
Review of Systems (ROS)
Relative Value Payment Schedules Method
Nodule
7. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Qualified diagnosis
Medically needy
History of present illness (HPI)
Birthday rule
8. poisoning was inflicted by another person with intent to kill or injure
Assault
Surgical Package
Pre-paid Health Plan
Fraud
9. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.
Inpatient
Category II Codes CPT
phalanges (phalanx.s)
Albino
10. 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
circle with a line through it)
Spinal/Vertebral Column
Macule
CPT SECTIONS.
11. represents Exemption from the use of modifier -51
circle with a line through it)
TRICARE PLANS
A plus sign (+)
Nodule
12. 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
Disability insurance
-99 - Multiple Modifiers
Birthday rule
Sections
13. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Parietal Bones
-50 - Bilateral Procedure
Mandible
Inferior nasal conchae
14. 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
Employer Liability
sebaceous(oil) glands and the suddoriferous (sweat) glands
ligaments
Accident
15. 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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16. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
False Claims Act (FCA)
Ischium
Outpatient
17. most synarthroses are immovable joints held together by fibrous tissue.
CPT SECTIONS.
No ROM
circle with a line through it)
Explanation of Benefits (EOB)
18. Groove or crack like sore
Fissure
Sections
Unlisted Procedures Procedures
Paper Claim
19. 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
Review of Systems (ROS)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
appendicular skeleton .
20. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
phalanges (phalanx.s)
Abuse
False Claims Act (FCA)
Electronic Claim
21. Poisoning cannot be determined whether intentional or accidental.
Greenstick
Undetermined
The Good Samaritan Act
phalanges (phalanx.s)
22. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
Carpals
axial skeleton
The Current Procedural Terminology (CPT)
False Claims Act (FCA)
23. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Coinsurance
Sections
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
24. 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....
Contracted Rates with MCOs
Frontal Bone
The St. Anthony Relative Value for Physicians (RVP)
Civil Monetary Penalties Law (CMPL)
25. 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
Rejected claim
Ulcermembranes
Full ROM
26. 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.
Birthday rule
Health Insurance Portability and Accountability Act (HIPAA)
-26 - Professional Component
Category II Codes CPT
27. 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
There are two types of sweat glands
Medicare Claim Status
Group Insurance
Colles
28. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Polyp
Medigap (Medicare Supplemental Insurance)
Unauthorized benefit
29. 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.
HCPCS Level II codes (National Codes)
Workers Compensation
triangle (a
Workers Compensation
30. The physician must obtain this number in order to practice within a state.
Point-of-Service plan (POS)
Indemnity Insurance
circle with a line through it)
State License Number
31. 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
Physician
Tabular List (Volume 1)...
Occipital Bone
Parietal Bones
32. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Deductible
Accept assignment
-32 - Mandated Services
Hairline
33. 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
Qualified diagnosis
Participating physician
Electronic Claim
Benign
34. 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.
Undetermined
Malignant
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
-99 - Multiple Modifiers
35. 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 -
Point-of-Service plan (POS)
true ribs
essential modifiers
Complicated
36. A fat cell
Pelvis
Lipocyte
Eligibility
co-payment
37. 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
upper appendicular skeleton
Accept assignment
Frontal Bone
38. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Tabular List (Volume 1)...
Medicaid
Clearinghouse
False ribs
39. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Inferior nasal conchae
Lipocyte
Participating physician
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
40. 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
Nodule
Carcinoma (Ca) in situ
Sub classification
Sebaceous glands
41. 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.
Full ROM
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
TRICARE
Add-on codes
42. A fracture of the epiphyseal plate in children.
Greenstick
Pre-authorization
-51 - Multiple Procedures
Salter-Harris
43. 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
Hypertension Table
Patient Confidentiality
Coordination of Benefits (COB)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
44. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
Compression fracture
Unspecified nature
Collagen
45. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
Fraud
Chapters
Lacrimal bones
A plus sign (+)
46. 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.
Medical Records
Blue Cross/Blue Shield Plans
Relative Value Payment Schedules Method
Colles
47. 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
phalanges (phalanx.s)
MEDICARE Part B
TRICARE PLANS
Compression fracture
48. 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
Capitated Rates
Paper Claim
Sections
Social Security Number
49. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Unique Provider Identification Number (UPIN)
Ulcermembranes
There are three layers to the skin
There are two types of sweat glands
50. the bone is crushed and or shattered.
Coding
Comminuted fracture
Pre-determination
Employee Liability
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