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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 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
A plus sign (+)
Evaluation and Management Review
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
2. The main term in the index may by followed by terms within parenthesis.
Alphabetic Index (Volume 2)
Categories
Fraud
The Patient Care Partnership (Patient's Bill of Rights)
3. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Benign (hypertension)
Participating physician
Fee-for-Service
Provider Identification Number (PIN)
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.'
true ribs
Malignant
Reasons for Documentation
Medical necessity
5. 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
Macule
Liability insurance
Abuse
6. 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.
lunula
Albino
-32 - Mandated Services
Inpatient
7. Consists of the skull - rib cage - and spine
axial skeleton
HCPCS Level II codes (National Codes)
Temporal Bone
Category II Codes CPT
8. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Chapters
Health practitioner
Fissure
9. Pre-determined set of benefits covered under one set annual fee.
Pre-paid Health Plan
Physician
Alopecia
MEDICAID COVERAGE
10. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Pre-certification
Advance Beneficiary Notice
Wheal
Column 1/Column 2 (previously called Comprehensive/Component) Edits
11. Is the lateral lower arm bone (in line with the thumb).
-32 - Mandated Services
Radius
Vomer
Accept assignment
12. Represents a new procedure or service code added since the previous edition of the manual.
bullet (a
Indemnity Insurance
Clean claim
Social Security Number
13. 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.
Pathologic
sprain
Personal Insurance
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
14. 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
Deductible
Health practitioner
Fee Schedule
Alphabetic Index (Volume 2)
15. Pre-determined set of benefits covered under one set annual fee.
Impetigo
Pre-paid Health Plan
The Universal Claim Form
Group Insurance
16. Any fracture occurring spontaneously as a result of disease.
Pathologic
Deductible
Radius
Sections
17. 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.
Sebaceous glands
New Patient
-26 - Professional Component
Gender rule
18. Benign growth extending from the surface of the mucous membrane
Malignant
encounter form
Polyp
Pre-determination
19. 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
Dirty claim
nonessential modifiers
Group Insurance
Invalid claim
20. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Abuse
Secondary malignancy
Category II Codes CPT
essential modifiers
21. 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 Patient Care Partnership (Patient's Bill of Rights)
History of present illness (HPI)
Unlisted Procedures Procedures
Zygoma
22. 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
CPT SECTIONS.
Long bones
The Patient Care Partnership (Patient's Bill of Rights)
Fiscal Intermediary
23. 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.
-50 - Bilateral Procedure
-32 - Mandated Services
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
circle with a line through it)
24. death of tissue associated with loss of blood supply
Coinsurance
Coordination of Benefits (COB)
Health Maintenance Organization (HMO)
Gangrene
25. The reason the patient came to see the physician.
Hypertension Table
Chief complaint (CC)
Sphenoid Bones
Full ROM
26. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Impetigo
Liability insurance
The Universal Claim Form
Hairline
27. poisoning was inflicted by another person with intent to kill or injure
There are three layers to the skin
Assault
Performing Provider Identification Number (PPIN)
Abuse
28. 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
stand-alone codes
Employer Liability
Point-of-Service plan (POS)
MEDICARE Part C
29. 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
Consultation
Parietal Bones
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Coordination of Benefits (COB)
30. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
Blue Cross/Blue Shield Plans
premium
Humerus
HCPCS Level II codes (National Codes)
31. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
triangle (a
Greenstick
Pathologic
Medicare
32. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Chief complaint
State License Number
Coinsurance
Health Insurance Portability and Accountability Act (HIPAA)
33. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Medigap (Medicare Supplemental Insurance)
False ribs
Performing Provider Identification Number (PPIN)
Blue Cross/Blue Shield Plans
34. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Coordination of Benefits (COB)
Colles
Radius
Reasons for Documentation
35. 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 -
-26 - Professional Component
Lipocyte
Indemnity Insurance
nonessential modifiers
36. is a traumatic injury to a joint involving the soft tissue.
Health practitioner
Parietal Bones
sprain
Birthday rule
37. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
upper appendicular skeleton
Medical necessity
Sphenoid Bones
Relative Value Payment Schedules Method
38. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
circle with a line through it)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
National Correct Coding Initiative (NCCI)
39. '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
Complicated
Employee Liability
Vesicle
Invalid claim
40. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Lipocyte
Vomer
Explanation of Benefits (EOB)
Tabular List (Volume 1)...
41. 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.
Advance Beneficiary Notice
Abuse
Outpatient
Employee Liability
42. 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
Unlisted Procedures Procedures
-51 - Multiple Procedures
History of present illness (HPI)
43. 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
Complicated
The Integumentary System
Gangrene
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
44. 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
Personal Insurance
Blue Cross/Blue Shield Plans
itemized statement
Preferred Provider Organization (PPO)
45. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
HCPCS Level II codes (National Codes)
Hairline
Primary malignancy
Nonparticipating physician
46. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Primary malignancy
Section 3 Index to External Causes of Injury (E codes)
Colles
Fiscal Intermediary
47. 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.
Parietal Bones
Palatine bones
Section 3 Index to External Causes of Injury (E codes)
Blue Cross/Blue Shield Plans
48. male of household is primary payer
TRICARE
Gender rule
-32 - Mandated Services
Retention of Medical Records
49. 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
Benign (hypertension)
Health practitioner
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
sprain
50. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
encounter form
Hypertension Table
Primary malignancy
Group practice