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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
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. 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
There are two types of sweat glands
Health Maintenance Organization (HMO)
circle with a line through it)
Mutually Exclusive Edits
2. uncertain whether benign or malignant; borderline malignancy
Uncertain behavior
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
eponychium
3. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
itemized statement
Carcinoma (Ca) in situ
Category II Codes CPT
Polyp
4. 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.'
Ischium
Participating physician
Uncertain behavior
Medical necessity
5. 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
Relative Value Payment Schedules Method
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Medicare
Sebaceous glands
6. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
No ROM
Invalid claim
-32 - Mandated Services
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
7. Deficient in pigment (melanin)
MEDICAID COVERAGE
Albino
Musculoskeletal System
Accident
8. - 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.
Remittance Advice
Unauthorized benefit
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
MEDICARE Part A
9. - 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
triangle (a
Medicaid
Medigap (Medicare Supplemental Insurance)
Collagen
10. 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
Primary malignancy
Humerus
The Integumentary System
Health Maintenance Organization (HMO)
11. Produce secretions that allow the body to be moisturized or cooled.
Tabular List (Volume 1)...
Radius
Colles
sebaceous(oil) glands and the suddoriferous (sweat) glands
12. most synarthroses are immovable joints held together by fibrous tissue.
Assault
No ROM
Medical Records
Comminuted fracture
13. 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
Reasons for Documentation
TRICARE
Nodule
Benign (hypertension)
14. 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.
Patient Confidentiality
Modifiers
Location Methods
Inferior nasal conchae
15. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Reasons for Documentation
Add-on codes
Employee Liability
Secondary malignancy
16. The bone is broken and pierces an internal organ
Complicated
Multigravida
Polyp
Accept assignment
17. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Past - family and social history (PFSH)
Vomer
Complicated
Location Methods
18. 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.
Pre-certification
-32 - Mandated Services
Deductible
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
19. 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
Sesamoid bones
MEDICARE Part C
Compression fracture
Provider Identification Number (PIN)
20. Are conditions - situations - and services not covered by the insurance carrier.
Abuse
Clearinghouse
State License Number
Exclusions and Limitations
21. Describes the services billed and includes a breakdown of how the payment is determined
Melanin
Explanation of Benefits (EOB)
-50 - Bilateral Procedure
Carcinoma (Ca) in situ
22. anterior to the temporal bones.
Sphenoid Bones
Medigap (Medicare Supplemental Insurance)
Category II Codes CPT
Long bones
23. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
phalanges (phalanx.s)
History of present illness (HPI)
Coinsurance
New patient
24. 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'.
Pre-authorization
Unlisted Procedures Procedures
Benign (hypertension)
Unspecified nature
25. The fractured area of bone collapses on itself.
Multigravida
Contracted Rates with MCOs
Compression fracture
Point-of-Service plan (POS)
26. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
The Good Samaritan Act
Sebaceous glands
False Claims Act (FCA)
Preferred Provider Organization (PPO)
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
Pre-authorization
-50 - Bilateral Procedure
Wheal
Unlisted Procedures Procedures
28. 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.
TRICARE
Surgical Package
Nonparticipating physician
Dirty claim
29. The moon like white area at the base of the nail.
lunula
-50 - Bilateral Procedure
Group Insurance
MEDICARE Part C
30. 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.
Pelvis
Albino
False Claims Act (FCA)
Carcinoma (Ca) in situ
31. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Zygoma
upper appendicular skeleton
Alphabetic Index (Volume 2)
32. 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
Maxilla
Macule
CPT SECTIONS.
Lipocyte
33. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Accept assignment
Participating physician
Flat bones
Full ROM
34. 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
New Patient
Electronic Claim
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Sub classification
35. 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
Macule
Accident
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Sebaceous glands
36. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Polyp
Employer Identification Number (EIN)
Carcinoma (Ca) in situ
stand-alone codes
37. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
The Current Procedural Terminology (CPT)
History
Assault
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
38. 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
False Claims Act (FCA)
stand-alone codes
Contracted Rates with MCOs
Outpatient
39. 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....
Lacrimal bones
The St. Anthony Relative Value for Physicians (RVP)
Primary malignancy
Multigravida
40. 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
Category II Codes CPT
The Current Procedural Terminology (CPT)
Birthday rule
The Universal Claim Form
41. 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
Pre-authorization
Blue Cross/Blue Shield Plans
-32 - Mandated Services
Mandible
42. is defined as one who has not received any medical services within the last three years.
New Patient
Long bones
phalanges (phalanx.s)
Liability insurance
43. The reason the patient came to see the physician.
Musculoskeletal System
Group Insurance
Palatine bones
Chief complaint (CC)
44. Is a working diagnosis which is not yet established.
Fee-for-Service
Hypertension Table
Medicare
Qualified diagnosis
45. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Humerus
Participating physician
Eligibility
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
46. 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
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
The St. Anthony Relative Value for Physicians (RVP)
Macule
Long bones
47. 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
Vomer
Patient Confidentiality
Mandible
Maxilla
48. Are composed of three-digit codes representing a single disease or condition.
Compression fracture
Gangrene
Employer Identification Number (EIN)
Categories
49. 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.
History of present illness (HPI)
nonessential modifiers
Primary malignancy
Fee Schedule
50. 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
Established Patient
Polyp
Group Insurance
Nodule