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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. solid - round or oval elevated lesion more than 1 cm in diameter
Fee Schedule
-50 - Bilateral Procedure
Impetigo
Nodule
2. Make up part of the interior of the nose.
Peer Review Organization (PRO)
History
Consultation
Inferior nasal conchae
3. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Alphabetic Index (Volume 2)
Inferior nasal conchae
Exclusions and Limitations
4. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Pathologic
Abuse
Medically needy
5. 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.
Paper Claim
-50 - Bilateral Procedure
Pre-determination
Carcinoma (Ca) in situ
6. Any fracture occurring spontaneously as a result of disease.
Pathologic
Paper Claim
Inpatient
There are three layers to the skin
7. - 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
Multigravida
Medigap (Medicare Supplemental Insurance)
Full ROM
Ischium
8. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Participating physician
Chapters
Unspecified nature
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
9. Noninvasive - non-spreading - nonmalignant
Benign
Relative Value Payment Schedules Method
Participating physician
History
10. The bone is broken and pierces an internal organ
History
Zygoma
Complicated
Fraud
11. 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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12. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Vomer
Carpals
sprain
State License Number
13. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Alphabetic Index (Volume 2)
Pre-certification
-90 - Reference (Outside) Laboratory
Accept assignment
14. 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
Remittance Advice
History of present illness (HPI)
Compliance Regulations
Paper Claim
15. A fracture of the epiphyseal plate in children.
Salter-Harris
Greenstick
Lipocyte
-26 - Professional Component
16. The lower anterior part of the bone
Sebaceous glands
Categorically needy -MEDICAID
Medicaid
Pubic bone
17. male of household is primary payer
Suicide Attempt
appendicular skeleton .
Medigap (Medicare Supplemental Insurance)
Gender rule
18. Is an electronic or paper-based report of payment sent by the payer to the provider.
Remittance Advice
TRICARE PLANS
Frontal Bone
Employer Liability
19. Typically not used on the claim form unless the provider does not have an EIN.
Ischium
Dirty claim
circle with a line through it)
Social Security Number
20. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Benign (hypertension)
Consultation
The Current Procedural Terminology (CPT)
-50 - Bilateral Procedure
21. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Health practitioner
Unlisted Procedures Procedures
Limited ROM
Neoplasm Table
22. 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.
Modifiers
Capitated Rates
Unique Provider Identification Number (UPIN)
triangle (a
23. 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.
Review of Systems (ROS)
eponychium
Physician
Benign
24. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
State License Number
The Universal Claim Form
Preferred Provider Organization (PPO)
Medicare
25. 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
Benign
Chief complaint (CC)
Pre-certification
26. 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
There are three layers to the skin
MEDICARE Part B
Inferior nasal conchae
The Integumentary System
27. 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 -
MEDICARE Part C
Indemnity Insurance
Abuse
Fee Schedule
28. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Commercial Carriers
Tabular List (Volume 1)...
Hypertension Table
-26 - Professional Component
29. Is a working diagnosis which is not yet established.
Categories
TRICARE
Qualified diagnosis
MEDICARE Part C
30. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Alphabetic Index (Volume 2)
Peer Review Organization (PRO)
A plus sign (+)
-50 - Bilateral Procedure
31. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
New patient
Medicare
Medically needy
Coding
32. Structural protein found in the skin and connective tissue
Gender rule
Collagen
Unspecified nature
Zygoma
33. Structural protein found in the skin and connective tissue
Full ROM
CPT SECTIONS.
Inpatient
Collagen
34. numbers 8-10 - are attached to the sternum by cartilage
Uncertain behavior
Assault
Fraud
False ribs
35. Forms the anterior part of the skull and the forehead
lunula
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Frontal Bone
36. Law passed by the federal government to prosecute cases of Medicaid fraud.
Civil Monetary Penalties Law (CMPL)
MEDICARE Part D
ligaments
Sub classification
37. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Rejected claim
The St. Anthony Relative Value for Physicians (RVP)
Keratin
Peer Review Organization (PRO)
38. 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.
Melanin
Neoplasm Table
Clean claim
Abuse
39. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Modifiers
CPT SECTIONS.
Employee Liability
40. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
No ROM
Alopecia
Category II Codes CPT
Chief complaint
41. The fractured area of bone collapses on itself.
Malignant
Zygoma
Compression fracture
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
42. The moon like white area at the base of the nail.
Inpatient
itemized statement
lunula
Lipocyte
43. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
The St. Anthony Relative Value for Physicians (RVP)
Fraud
Social Security Number
There are three layers to the skin
44. 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.
Musculoskeletal System
Hairline
Personal Insurance
Sub classification
45. 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.
No ROM
Liability insurance
Alopecia
Group Provider Number
46. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Pathologic
The Good Samaritan Act
Employer Identification Number (EIN)
Pre-authorization
47. 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'.
Birthday rule
The Integumentary System
Pre-authorization
axial skeleton
48. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Sphenoid Bones
Flat bones
Vomer
Employer Identification Number (EIN)
49. Small collection of clear fluid;blister
Wheal
Vesicle
-50 - Bilateral Procedure
triangle (a
50. 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
Participating physician
Lipocyte
Capitated Rates
The Universal Claim Form