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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. 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.
Health Insurance Portability and Accountability Act (HIPAA)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
New patient
-26 - Professional Component
2. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.
HCPCS Level I codes
Group Provider Number
Humerus
Colles
3.
bullet (a
National Correct Coding Initiative (NCCI)
Vesicle
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
4. 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
Coding
Peer Review Organization (PRO)
Social Security Number
stand-alone codes
5. 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
Long bones
Compression fracture
Macule
Group Insurance
6. 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:
Employee Liability
Category II Codes CPT
Hypertension Table
bullet (a
7. Forms the sides of the cranium
Parietal Bones
Personal Insurance
Inpatient
Employee Liability
8. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Indemnity Insurance
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
triangle (a
Medicaid
9. Represent changes in the text or definition between the triangles.
Lacrimal bones
Two triangular symbols (a
Health Insurance Portability and Accountability Act (HIPAA)
bullet (a
10. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
New patient
Outpatient
Medically needy
Retention of Medical Records
11. The physician must obtain this number in order to practice within a state.
Sub classification
State License Number
Pre-determination
Medical Records
12. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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13. 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
Pre-certification
Relative Value Payment Schedules Method
-26 - Professional Component
Fee Schedule
14. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Gender rule
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Secondary malignancy
Deductible
15. 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
Greenstick
Health Insurance Portability and Accountability Act (HIPAA)
Compression fracture
16. uncertain whether benign or malignant; borderline malignancy
Uncertain behavior
MEDICARE Part C
The Good Samaritan Act
CPT SECTIONS.
17. The physician must obtain this number in order to practice within a state.
Impacted
The Current Procedural Terminology (CPT)
Occipital Bone
State License Number
18. 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
MEDICARE Part D
Pelvis
Categorically needy -MEDICAID
Group Insurance
19. 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.
TRICARE PLANS
-32 - Mandated Services
Patient Confidentiality
Patient Confidentiality
20. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Benign
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Impetigo
21. 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
Greenstick
Coinsurance
No ROM
Outpatient
22. 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.
Palatine bones
Physician
Humerus
Health practitioner
23. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
Health practitioner
Unspecified (hypertension)
Surgical Package
24. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
Carpals
upper appendicular skeleton
Outpatient
Medicaid
25. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Ethmoid Bone
Subcategories
A plus sign (+)
Sections
26. 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.
Pre-authorization
False Claims Act (FCA)
Group Insurance
Commercial Carriers
27. 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.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
triangle (a
Parietal Bones
ulna
28. 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
Workers Compensation
MEDICAID COVERAGE
Qualified diagnosis
Fraud
29. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
Non-covered benefit
Coordination of Benefits (COB)
HCPCS Level II codes (National Codes)
Outpatient
30. 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
Relative Value Payment Schedules Method
Accident
MEDICARE Part C
Melanin
31. 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
Frontal Bone
Radius
The Universal Claim Form
Comminuted fracture
32. 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
Chief complaint (CC)
sprain
Medicare Claim Status
33. 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
Clearinghouse
Temporal Bone
Category III Codes CPT
phalanges (phalanx.s)
34. 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 -
essential modifiers
ligaments
Accept assignment
Medigap (Medicare Supplemental Insurance)
35. 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
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Peer Review Organization (PRO)
Medicare Claim Status
Vomer
36. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
MEDICAID COVERAGE
TRICARE
37. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
Health practitioner
Contracted Rates with MCOs
National Correct Coding Initiative (NCCI)
Social Security Number
38. 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.
Dirty claim
Humerus
Macule
Nonparticipating physician
39. 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.
-26 - Professional Component
Ethmoid Bone
encounter form
Medical Records
40. solid - round or oval elevated lesion more than 1 cm in diameter
Category II Codes CPT
Patient Confidentiality
Nodule
Salter-Harris
41. 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.
Preferred Provider plan
Comminuted fracture
State License Number
TRICARE
42. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Birthday rule
Peer Review Organization (PRO)
Ulcermembranes
MEDICARE Part C
43. 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....
There are three layers to the skin
Alopecia
The St. Anthony Relative Value for Physicians (RVP)
Sesamoid bones
44. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Macule
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Consultation
Pelvis
45. is defined as one who has not received any medical services within the last three years.
Location Methods
Pre-determination
New Patient
Category I Codes CPT
46. Is a working diagnosis which is not yet established.
Pre-paid Health Plan
Qualified diagnosis
Ulcermembranes
There are two types of sweat glands
47. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Hypertension Table
Malignant
Modifiers
appendicular skeleton .
48. The moon like white area at the base of the nail.
Birthday rule
Rejected claim
Remittance Advice
lunula
49. The reason the patient came to see the physician.
Established Patient
New patient
Chief complaint (CC)
Coordination of Benefits (COB)
50. 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.
Keratin
Malignant
nonessential modifiers
Electronic Claim