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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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 the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Modifiers
Non-covered benefit
premium
The Good Samaritan Act
2. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Pre-paid Health Plan
Medicare Claim Status
Flat bones
HCPCS Level II codes (National Codes)
3. 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.
Personal Insurance
Lacrimal bones
No ROM
premium
4. - 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.
Fee Schedule
Non-covered benefit
Inpatient
Unauthorized benefit
5. The reason the patient came to see the physician.
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Qualified diagnosis
Alopecia
Chief complaint (CC)
6. The cuticle at the lower part of the nail and this is sometimes referred to as the
Health Insurance Portability and Accountability Act (HIPAA)
encounter form
Retention of Medical Records
eponychium
7. 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
-99 - Multiple Modifiers
Section 3 Index to External Causes of Injury (E codes)
Gender rule
8. Contains complete - necessary information - but is incorrect or illogical in some way.
Occipital Bone
Invalid claim
The Universal Claim Form
Neoplasm Table
9. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
Impacted
-51 - Multiple Procedures
itemized statement
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
10. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Benign
-50 - Bilateral Procedure
Vesicle
State License Number
11. 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.
Performing Provider Identification Number (PPIN)
Medicare
Compression fracture
Mandible
12. Most billing-related cases are based on HIPAA and False Claims Act.
Preferred Provider Organization (PPO)
Group practice
Compliance Regulations
Gender rule
13. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Indemnity Insurance
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
The Universal Claim Form
Workers Compensation
14. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
Unique Provider Identification Number (UPIN)
Vomer
Retention of Medical Records
National Correct Coding Initiative (NCCI)
15. Groove or crack like sore
Fissure
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Mutually Exclusive Edits
Fraud
16. 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
Commercial Carriers
Health practitioner
Established patient
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
17. 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.
Clean claim
Impetigo
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Invalid claim
18. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
Invalid claim
upper appendicular skeleton
Medically needy
Blue Cross/Blue Shield Plans
19. 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
Location Methods
Sebaceous glands
Ethmoid Bone
Polyp
20. Benign growth extending from the surface of the mucous membrane
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Unlisted Procedures Procedures
Section 3 Index to External Causes of Injury (E codes)
Polyp
21. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Employee Liability
HCPCS Level I codes
Complicated
22. 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 -
The Universal Claim Form
TRICARE PLANS
Coordination of Benefits (COB)
Indemnity Insurance
23. Forms the anterior part of the skull and the forehead
Alphabetic Index (Volume 2)
Compliance Regulations
-50 - Bilateral Procedure
Frontal Bone
24. Are conditions - situations - and services not covered by the insurance carrier.
Clearinghouse
Exclusions and Limitations
essential modifiers
Sesamoid bones
25. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
Undetermined
Pre-paid Health Plan
False Claims Act (FCA)
26. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Comminuted fracture
Fraud
Keratin
Humerus
27. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Chief complaint (CC)
Radius
TRICARE
28. Is made up of the shoulder - collar - pelvic and arms and legs
Neoplasm Table
Maxilla
Carpals
appendicular skeleton .
29. Is one who has no contract with the health insurance plan.
Sections
TRICARE
Nonparticipating physician
Chapters
30. Represents a new procedure or service code added since the previous edition of the manual.
Carpals
bullet (a
Review of Systems (ROS)
Category I Codes CPT
31. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Chief complaint (CC)
encounter form
False ribs
Remittance Advice
32. 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
Medical Records
Past - family and social history (PFSH)
itemized statement
Group Provider Number
33. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Civil Monetary Penalties Law (CMPL)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Inpatient
Wheal
34. 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:
Hypertension Table
Short bones
Preferred Provider Organization (PPO)
Long bones
35. 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.
ulna
Preferred Provider plan
-26 - Professional Component
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
36. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Medical Records
Pre-paid Health Plan
Rejected claim
Established patient
37. 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
Inpatient
Paper Claim
Clean claim
Physician
38. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
axial skeleton
Medigap (Medicare Supplemental Insurance)
Category I Codes CPT
Disability insurance
39. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
-50 - Bilateral Procedure
Review of Systems (ROS)
Personal Insurance
Vomer
40. 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
Unique Provider Identification Number (UPIN)
Employee Liability
Location Methods
The Current Procedural Terminology (CPT)
41. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Greenstick
TRICARE PLANS
Albino
42. This is a set of information the physician gathers from the patient regarding the following:
History
Surgical Package
sebaceous(oil) glands and the suddoriferous (sweat) glands
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
43. is defined as one who has not received any medical services within the last three years.
Maxilla
New Patient
Unspecified (hypertension)
Social Security Number
44. 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
Explanation of Benefits (EOB)
False Claims Act (FCA)
ulna
45. 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
Paper Claim
Hairline
Group Insurance
Occipital Bone
46. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
Performing Provider Identification Number (PPIN)
The Current Procedural Terminology (CPT)
Electronic Claim
47. Forms the sides of the cranium
MEDICARE Part B
phalanges (phalanx.s)
phalanges (phalanx.s)
Parietal Bones
48. 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
Peer Review Organization (PRO)
Employer Identification Number (EIN)
Patient Confidentiality
The Current Procedural Terminology (CPT)
49. 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
MEDICARE Part D
Nonparticipating physician
Electronic Claim
Short bones
50. 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
Sesamoid bones
Category I Codes CPT
MEDICAID COVERAGE