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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. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
Radius
MEDICARE Part C
Subcategories
2. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Coding
Pre-determination
Fraud
The Good Samaritan Act
3. 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.
Participating physician
nonessential modifiers
Medicare Claim Status
Pre-paid Health Plan
4. The reason the patient came to see the physician.
Category I Codes CPT
Group Provider Number
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Chief complaint (CC)
5. 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.
National Correct Coding Initiative (NCCI)
appendicular skeleton .
Ischium
axial skeleton
6. Is one who has no contract with the health insurance plan.
-50 - Bilateral Procedure
The St. Anthony Relative Value for Physicians (RVP)
Nonparticipating physician
Review of Systems (ROS)
7. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Preferred Provider plan
Performing Provider Identification Number (PPIN)
Primary malignancy
Personal Insurance
8. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
Parietal Bones
Impetigo
Employer Liability
Advance Beneficiary Notice
9. 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
Location Methods
Abuse
Group Insurance
Categorically needy -MEDICAID
10. The main term in the index may by followed by terms within parenthesis.
encounter form
Medicare
Evaluation and Management Review
Alphabetic Index (Volume 2)
11. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Categorically needy -MEDICAID
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Unique Provider Identification Number (UPIN)
Ulcermembranes
12. Is made up of the shoulder - collar - pelvic and arms and legs
appendicular skeleton .
Hypertension Table
Clearinghouse
Health Maintenance Organization (HMO)
13. 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.
Pre-certification
Advance Beneficiary Notice
Benign
-99 - Multiple Modifiers
14. 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....
Tabular List (Volume 1)...
There are two types of sweat glands
Established patient
No ROM
15. 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.
Maxilla
The Universal Claim Form
Category II Codes CPT
False Claims Act (FCA)
16. 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.
Carcinoma (Ca) in situ
Pre-authorization
Advance Beneficiary Notice
Impetigo
17. represents Exemption from the use of modifier -51
circle with a line through it)
Review of Systems (ROS)
National Correct Coding Initiative (NCCI)
MEDICARE Part A
18. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Carpals
Medical necessity
Invalid claim
Secondary malignancy
19. 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
itemized statement
Location Methods
Short bones
Indemnity Insurance
20. solid - round or oval elevated lesion more than 1 cm in diameter
Employer Liability
Nodule
Secondary malignancy
Preferred Provider Organization (PPO)
21. 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
Consultation
Long bones
Unlisted Procedures Procedures
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
22. 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
bullet (a
Greenstick
Inpatient
ligaments
23. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).
Mandible
Carcinoma (Ca) in situ
Sections
Clean claim
24. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Humerus
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Keratin
Deductible
25. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu
Neoplasm Table
No ROM
Lacrimal bones
nonessential modifiers
26. 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
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Alphabetic Index (Volume 2)
Assault
Health Maintenance Organization (HMO)
27. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
The Integumentary System
Unlisted Procedures Procedures
There are two types of sweat glands
bullet (a
28. Upper jaw bone
Qualified diagnosis
Coordination of Benefits (COB)
Indemnity Insurance
Maxilla
29. Number assigned to the physician by Medicare program.
Unique Provider Identification Number (UPIN)
Relative Value Payment Schedules Method
Eligibility
Column 1/Column 2 (previously called Comprehensive/Component) Edits
30. Law passed by the federal government to prosecute cases of Medicaid fraud.
Two triangular symbols (a
Civil Monetary Penalties Law (CMPL)
triangle (a
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
31. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
upper appendicular skeleton
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Accept assignment
32. Mild or controlled hypertension and no damage to the vascular system or organs.
Non-covered benefit
Benign (hypertension)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
MEDICARE Part D
33. Pre-determined set of benefits covered under one set annual fee.
False Claims Act (FCA)
Pre-paid Health Plan
Peer Review Organization (PRO)
Review of Systems (ROS)
34. 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.
itemized statement
premium
Pre-determination
Subcategories
35. 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.
Carpals
Long bones
Rejected claim
New patient
36. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Impetigo
Deductible
Subcategories
37. '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
Group Insurance
Clean claim
Zygoma
Employee Liability
38. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
Neoplasm Table
Consultation
HCPCS Level I codes
nonessential modifiers
39. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Disability insurance
appendicular skeleton .
encounter form
Participating physician
40. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
Coinsurance
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Clean claim
TRICARE PLANS
41. 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
Disability insurance
Employee Liability
Alopecia
42. Forms the sides of the cranium
Assault
The Patient Care Partnership (Patient's Bill of Rights)
Health Care Financing Administration Common Procedure Coding System
Parietal Bones
43. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
premium
Health Insurance Portability and Accountability Act (HIPAA)
Medicare
lunula
44. The cuticle at the lower part of the nail and this is sometimes referred to as the
False Claims Act (FCA)
Hairline
eponychium
Remittance Advice
45. Is the lateral lower arm bone (in line with the thumb).
Patient Confidentiality
Radius
Categorically needy -MEDICAID
TRICARE PLANS
46. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
Zygoma
-26 - Professional Component
CPT SECTIONS.
Collagen
47. The bone is broken and pierces an internal organ
Complicated
Fee Schedule
New patient
Modifiers
48. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
Wheal
Parietal Bones
Category II Codes CPT
upper appendicular skeleton
49. 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.
axial skeleton
Location Methods
False Claims Act (FCA)
co-payment
50. the bone is crushed and or shattered.
Point-of-Service plan (POS)
ulna
Comminuted fracture
Past - family and social history (PFSH)