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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. 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
Coding
Reasons for Documentation
Categories
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
2. Numbers 1-7 - attach directly to the sternum in the front of the body.
Explanation of Benefits (EOB)
Chapters
true ribs
The Integumentary System
3. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
Pelvis
lunula
-90 - Reference (Outside) Laboratory
4. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Section 3 Index to External Causes of Injury (E codes)
Exclusions and Limitations
There are two types of sweat glands
triangle (a
5. Most billing-related cases are based on HIPAA and False Claims Act.
Subcategories
Compliance Regulations
Pelvis
Employee Liability
6. 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
Liability insurance
TRICARE
HCPCS Level II codes (National Codes)
HCPCS Level II codes (National Codes)
7. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Undetermined
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Salter-Harris
-51 - Multiple Procedures
8. Mild or controlled hypertension and no damage to the vascular system or organs.
appendicular skeleton .
Full ROM
Benign (hypertension)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
9. 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
essential modifiers
Neoplasm Table
Carcinoma (Ca) in situ
MEDICARE Part D
10. Small collection of clear fluid;blister
Vesicle
Provider Identification Number (PIN)
MEDICARE Part D
Unspecified (hypertension)
11. Most billing-related cases are based on HIPAA and False Claims Act.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Compliance Regulations
Established Patient
Humerus
12. 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
Paper Claim
Relative Value Payment Schedules Method
Contracted Rates with MCOs
Sesamoid bones
13. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
-90 - Reference (Outside) Laboratory
Physician
Benign
sebaceous(oil) glands and the suddoriferous (sweat) glands
14. 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
Chief complaint
Coordination of Benefits (COB)
Assault
Blue Cross/Blue Shield Plans
15. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Accept assignment
Birthday rule
Secondary malignancy
Inpatient
16. 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
Fraud
TRICARE PLANS
Provider Identification Number (PIN)
Sub classification
17. 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
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Location Methods
Ischium
The Universal Claim Form
18. are small with irregular shapes. They are found in the wrist and ankle.
MEDICARE Part D
Short bones
Chapters
Hypertension Table
19. 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..
-90 - Reference (Outside) Laboratory
Patient Confidentiality
Qualified diagnosis
Musculoskeletal System
20. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
The Integumentary System
History
Two triangular symbols (a
21. 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
TRICARE
Impacted
Disability insurance
Consultation
22. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Collagen
Birthday rule
Workers Compensation
Hairline
23. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Assault
Medically needy
HCPCS Level II codes (National Codes)
Coordination of Benefits (COB)
24.
MEDICARE Part D
essential modifiers
Group Provider Number
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
25. 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
Short bones
premium
Electronic Claim
lunula
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.
False Claims Act (FCA)
Two triangular symbols (a
Surgical Package
Established patient
27. Contains complete - necessary information - but is incorrect or illogical in some way.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Invalid claim
Group Insurance
Unspecified (hypertension)
28. Structural protein found in the skin and connective tissue
Carpals
Collagen
Civil Monetary Penalties Law (CMPL)
Occipital Bone
29. 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.
HCPCS Level II codes (National Codes)
Unspecified nature
Personal Insurance
The Integumentary System
30. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Unspecified nature
Fee-for-Service
Section 3 Index to External Causes of Injury (E codes)
Sub classification
31. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
ulna
Workers Compensation
Rib Cage
Abuse
32. 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
Blue Cross/Blue Shield Plans
Compression fracture
Outpatient
Fissure
33. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
CPT SECTIONS.
Participating physician
Surgical Package
Flat bones
34. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Primary malignancy
Fee-for-Service
Unauthorized benefit
Section 3 Index to External Causes of Injury (E codes)
35. represents Exemption from the use of modifier -51
circle with a line through it)
Multigravida
Ulcermembranes
Flat bones
36. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
Colles
Peer Review Organization (PRO)
Temporal Bone
37. 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
Employer Liability
MEDICAID COVERAGE
Secondary malignancy
Gender rule
38. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Preferred Provider Organization (PPO)
Maxilla
New Patient
Long bones
39. 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.
Abuse
Chapters
Medicare Claim Status
Dirty claim
40. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
-99 - Multiple Modifiers
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Fee-for-Service
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
41. 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
axial skeleton
Collagen
Capitated Rates
Categories
42. make up part of the roof of the mouth
MEDICARE Part C
Employer Identification Number (EIN)
Pre-certification
Palatine bones
43. Pre-determined set of benefits covered under one set annual fee.
CPT SECTIONS.
appendicular skeleton .
Pathologic
Pre-paid Health Plan
44. 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
Colles
A plus sign (+)
Unauthorized benefit
45. 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.
Unlisted Procedures Procedures
encounter form
Inpatient
Abuse
46. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Fiscal Intermediary
Impacted
Deductible
Long bones
47. 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
Disability insurance
Maxilla
Pre-determination
Occipital Bone
48. 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).
Fee-for-Service
Frontal Bone
-51 - Multiple Procedures
Sections
49. requires investigation and needs further clarification.
MEDICAID COVERAGE
Rejected claim
Uncertain behavior
The Current Procedural Terminology (CPT)
50. Indicates add-on codes
A plus sign (+)
Relative Value Payment Schedules Method
False Claims Act (FCA)
Ethmoid Bone