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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 managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Compression fracture
Health Maintenance Organization (HMO)
Point-of-Service plan (POS)
There are three layers to the skin
2. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
HCPCS Level II codes (National Codes)
Accident
Participating physician
Unauthorized benefit
3. Consists of the skull - rib cage - and spine
Palatine bones
axial skeleton
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Dirty claim
4. 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
MEDICAID COVERAGE
Health Maintenance Organization (HMO)
itemized statement
5. 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
National Correct Coding Initiative (NCCI)
Sub classification
Established Patient
nonessential modifiers
6. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Fraud
Unspecified nature
Lipocyte
7. Number assigned to the physician by Medicare program.
Melanin
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Unique Provider Identification Number (UPIN)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
8. .. lower jaw bone.
MEDICARE Part D
State License Number
Mandible
Deductible
9. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
MEDICARE Part C
Indemnity Insurance
New patient
Contracted Rates with MCOs
10. Is an electronic or paper-based report of payment sent by the payer to the provider.
Impetigo
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Remittance Advice
Patient Confidentiality
11. 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
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Tabular List (Volume 1)...
Musculoskeletal System
12. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Albino
Nonparticipating physician
Subcategories
History of present illness (HPI)
13. Is made up of the shoulder - collar - pelvic and arms and legs
Outpatient
Advance Beneficiary Notice
appendicular skeleton .
History of present illness (HPI)
14. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
Non-covered benefit
Gender rule
False ribs
Fee-for-Service
15. Is made up of the shoulder - collar - pelvic and arms and legs
Long bones
Comminuted fracture
appendicular skeleton .
sprain
16. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Explanation of Benefits (EOB)
Pelvis
New patient
History of present illness (HPI)
17. 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 -
Explanation of Benefits (EOB)
Commercial Carriers
Coding
essential modifiers
18. 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
There are three layers to the skin
Abuse
-99 - Multiple Modifiers
Pelvis
19. Are composed of three-digit codes representing a single disease or condition.
Contracted Rates with MCOs
Categories
State License Number
true ribs
20. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
The St. Anthony Relative Value for Physicians (RVP)
Benign
Fee-for-Service
Temporal Bone
21. 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
Non-covered benefit
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Unauthorized benefit
sebaceous(oil) glands and the suddoriferous (sweat) glands
22. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Long bones
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Impetigo
stand-alone codes
23. The cuticle at the lower part of the nail and this is sometimes referred to as the
Blue Cross/Blue Shield Plans
eponychium
Ischium
Qualified diagnosis
24. Is the lower medial arm bone.
Carpals
Suicide Attempt
ulna
Collagen
25. A pregnant woman who has had at least one previous pregnancy.
Add-on codes
Impacted
Multigravida
Point-of-Service plan (POS)
26. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Collagen
Contracted Rates with MCOs
Inpatient
Health Insurance Portability and Accountability Act (HIPAA)
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
TRICARE PLANS
Health Insurance Portability and Accountability Act (HIPAA)
Unlisted Procedures Procedures
Employer Identification Number (EIN)
28. 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
Vomer
Capitated Rates
False Claims Act (FCA)
Employer Liability
29. Cheekbone
Two triangular symbols (a
State License Number
Ethmoid Bone
Zygoma
30. 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
upper appendicular skeleton
Exclusions and Limitations
The Patient Care Partnership (Patient's Bill of Rights)
New Patient
31. 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
Outpatient
Alopecia
Fee Schedule
Relative Value Payment Schedules Method
32. 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.
Zygoma
Past - family and social history (PFSH)
Alopecia
Personal Insurance
33. 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.
Assault
Pre-determination
Inferior nasal conchae
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
34. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
Accident
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Abuse
False Claims Act (FCA)
35. Structural protein found in the skin and connective tissue
Polyp
Compliance Regulations
Collagen
appendicular skeleton .
36. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Health Care Financing Administration Common Procedure Coding System
Medically needy
Carcinoma (Ca) in situ
Pre-certification
37. paired bones at the corner of each eye that cradle the tear ducts.
bullet (a
Lacrimal bones
Sebaceous glands
Employer Liability
38. 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).
Sections
Group Provider Number
Frontal Bone
Compliance Regulations
39. 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
Pre-paid Health Plan
Rejected claim
The Integumentary System
Unauthorized benefit
40. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
There are three layers to the skin
Pre-paid Health Plan
There are two types of sweat glands
Eligibility
41. 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.
Lipocyte
-32 - Mandated Services
Clearinghouse
Nodule
42. Is the qualifying factor or factors that must be met before a patient receives benefits.
Mutually Exclusive Edits
Multigravida
Eligibility
Categories
43. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
Coordination of Benefits (COB)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Social Security Number
44. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
The Good Samaritan Act
Fraud
Consultation
45. major skin pigment
History of present illness (HPI)
-32 - Mandated Services
There are three layers to the skin
Melanin
46. Mild or controlled hypertension and no damage to the vascular system or organs.
Alopecia
The Good Samaritan Act
Musculoskeletal System
Benign (hypertension)
47. Small collection of clear fluid;blister
Lacrimal bones
Collagen
Vesicle
Category III Codes CPT
48. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Hypertension Table
Tabular List (Volume 1)...
encounter form
Salter-Harris
49. 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..
Musculoskeletal System
Pelvis
Group Provider Number
Unlisted Procedures Procedures
50. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin
-51 - Multiple Procedures
Lacrimal bones
Advance Beneficiary Notice
Non-covered benefit