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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.
If you are not ready to take this test, you can
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. 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
Health Insurance Portability and Accountability Act (HIPAA)
Melanin
Unspecified (hypertension)
2. Forms the sides of the cranium
Rejected claim
Lipocyte
Carpals
Parietal Bones
3. 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.
Gender rule
Group Insurance
Medical Records
New Patient
4. 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
Vesicle
Musculoskeletal System
HCPCS Level II codes (National Codes)
Occipital Bone
5. 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
Coding
Electronic Claim
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
6. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.
A plus sign (+)
TRICARE PLANS
Medical necessity
Preferred Provider plan
7. Indicates add-on codes
Vesicle
Neoplasm Table
Add-on codes
A plus sign (+)
8. represents Exemption from the use of modifier -51
Fissure
Medical Records
circle with a line through it)
-32 - Mandated Services
9. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Hairline
Employer Identification Number (EIN)
Vesicle
History
10. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
stand-alone codes
MEDICARE Part C
A plus sign (+)
Health practitioner
11. Forms the sides of the cranium
TRICARE
Clean claim
Parietal Bones
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
12. 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
A plus sign (+)
Group practice
Patient Confidentiality
triangle (a
13. 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.
Exclusions and Limitations
Pre-determination
National Correct Coding Initiative (NCCI)
Medicare
14. Describes the services billed and includes a breakdown of how the payment is determined
New patient
Complicated
Explanation of Benefits (EOB)
Remittance Advice
15. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Contracted Rates with MCOs
Unauthorized benefit
Deductible
Medical necessity
16. 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
Non-covered benefit
eponychium
Compression fracture
17. Structural protein found in the skin and connective tissue
Retention of Medical Records
Suicide Attempt
-99 - Multiple Modifiers
Collagen
18. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
Compliance Regulations
MEDICARE Part C
Preferred Provider plan
Medigap (Medicare Supplemental Insurance)
19. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Paper Claim
-51 - Multiple Procedures
Point-of-Service plan (POS)
Accept assignment
20. Is an electronic or paper-based report of payment sent by the payer to the provider.
Remittance Advice
Health Insurance Portability and Accountability Act (HIPAA)
Vomer
The Integumentary System
21. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
bullet (a
Group practice
Peer Review Organization (PRO)
Medigap (Medicare Supplemental Insurance)
22. 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
MEDICARE Part A
Category II Codes CPT
Fee-for-Service
Spinal/Vertebral Column
23. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
Health Care Financing Administration Common Procedure Coding System
Fee Schedule
Ischium
phalanges (phalanx.s)
24. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.
Point-of-Service plan (POS)
Temporal Bone
Category III Codes CPT
Retention of Medical Records
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
Peer Review Organization (PRO)
The Universal Claim Form
Accident
Patient Confidentiality
26. '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
Frontal Bone
Employee Liability
Established Patient
Polyp
27. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Pre-determination
Participating physician
Benign
Location Methods
28. is defined as one who has not received any medical services within the last three years.
Temporal Bone
Review of Systems (ROS)
Carpals
New Patient
29. The lower anterior part of the bone
New patient
Pubic bone
Compliance Regulations
State License Number
30. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Pre-paid Health Plan
Medicare Claim Status
appendicular skeleton .
Personal Insurance
31. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Birthday rule
Participating physician
Gender rule
Point-of-Service plan (POS)
32. Benign growth extending from the surface of the mucous membrane
Retention of Medical Records
Preferred Provider Organization (PPO)
Remittance Advice
Polyp
33. 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.
stand-alone codes
phalanges (phalanx.s)
Colles
Impetigo
34. Is a working diagnosis which is not yet established.
Qualified diagnosis
Preferred Provider Organization (PPO)
New Patient
Pre-authorization
35. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Musculoskeletal System
Rib Cage
Hypertension Table
Add-on codes
36. 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....
Category II Codes CPT
Point-of-Service plan (POS)
Established patient
Unauthorized benefit
37. requires investigation and needs further clarification.
The Current Procedural Terminology (CPT)
Rejected claim
Lipocyte
Clearinghouse
38. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
eponychium
HCPCS Level I codes
Health Insurance Portability and Accountability Act (HIPAA)
itemized statement
39. 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.
Physician
Flat bones
Unique Provider Identification Number (UPIN)
Colles
40. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
Pubic bone
essential modifiers
MEDICAID COVERAGE
National Correct Coding Initiative (NCCI)
41. 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:
Coding
-51 - Multiple Procedures
Hypertension Table
triangle (a
42. 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.
The Universal Claim Form
sebaceous(oil) glands and the suddoriferous (sweat) glands
-32 - Mandated Services
encounter form
43. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi
Health Maintenance Organization (HMO)
upper appendicular skeleton
essential modifiers
bullet (a
44. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
Add-on codes
There are three layers to the skin
TRICARE
National Correct Coding Initiative (NCCI)
45. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Assault
Macule
Consultation
Primary malignancy
46. 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
Alphabetic Index (Volume 2)
Assault
Consultation
47. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Sphenoid Bones
Preferred Provider plan
Accept assignment
Category II Codes CPT
48. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Health Care Financing Administration Common Procedure Coding System
State License Number
Contracted Rates with MCOs
Column 1/Column 2 (previously called Comprehensive/Component) Edits
49. 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 -
Inpatient
essential modifiers
Albino
Carcinoma (Ca) in situ
50. Is made up of the shoulder - collar - pelvic and arms and legs
Group Provider Number
appendicular skeleton .
The Patient Care Partnership (Patient's Bill of Rights)
History