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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.
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. This is a set of information the physician gathers from the patient regarding the following:
History
National Correct Coding Initiative (NCCI)
Group Insurance
TRICARE PLANS
2. 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
Employee Liability
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Hypertension Table
Paper Claim
3. Discolored - flat lesion (freckles - tattoo marks)
Categorically needy -MEDICAID
Macule
Inpatient
Employee Liability
4. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Blue Cross/Blue Shield Plans
Patient Confidentiality
Limited ROM
Palatine bones
5. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
Macule
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Vomer
Non-covered benefit
6. Consists of the skull - rib cage - and spine
Greenstick
axial skeleton
TRICARE
Fee Schedule
7. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
The Universal Claim Form
lunula
Group practice
MEDICARE Part C
8. 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
triangle (a
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Blue Cross/Blue Shield Plans
Point-of-Service plan (POS)
9. 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
TRICARE
Musculoskeletal System
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Pre-authorization
10. 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).
Sphenoid Bones
phalanges (phalanx.s)
Preferred Provider plan
Sections
11. 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
Pathologic
Non-covered benefit
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Health practitioner
12. Represents a new procedure or service code added since the previous edition of the manual.
Multigravida
Group Insurance
Vesicle
bullet (a
13. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Capitated Rates
Group Provider Number
Health Care Financing Administration Common Procedure Coding System
14. 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
Chief complaint (CC)
Coding
upper appendicular skeleton
Blue Cross/Blue Shield Plans
15. Is the qualifying factor or factors that must be met before a patient receives benefits.
Explanation of Benefits (EOB)
Eligibility
Temporal Bone
Deductible
16. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Established Patient
HCPCS Level I codes
Malignant
Fiscal Intermediary
17. .. lower jaw bone.
Sub classification
Remittance Advice
premium
Mandible
18. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Radius
nonessential modifiers
Coinsurance
National Correct Coding Initiative (NCCI)
19. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Outpatient
Peer Review Organization (PRO)
Abuse
Polyp
20. 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
Group Insurance
Unauthorized benefit
Qualified diagnosis
Long bones
21. paired bones at the corner of each eye that cradle the tear ducts.
Advance Beneficiary Notice
Short bones
Parietal Bones
Lacrimal bones
22. most synarthroses are immovable joints held together by fibrous tissue.
Subcategories
No ROM
Category I Codes CPT
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
23. Is the lateral lower arm bone (in line with the thumb).
axial skeleton
Radius
Pre-determination
Accept assignment
24. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
essential modifiers
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
itemized statement
Category III Codes CPT
25. Structural protein found in the skin and connective tissue
Short bones
Inpatient
Fiscal Intermediary
Collagen
26. Law passed by the federal government to prosecute cases of Medicaid fraud.
Group Provider Number
Civil Monetary Penalties Law (CMPL)
Patient Confidentiality
Lipocyte
27. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Keratin
Group practice
Full ROM
28. Groove or crack like sore
Zygoma
Fissure
Short bones
Temporal Bone
29. Discolored - flat lesion (freckles - tattoo marks)
There are two types of sweat glands
Macule
Sphenoid Bones
The Current Procedural Terminology (CPT)
30. Are composed of three-digit codes representing a single disease or condition.
phalanges (phalanx.s)
Categories
The St. Anthony Relative Value for Physicians (RVP)
Chapters
31. This is not specified as benign or malignant in the diagnosis or medical record.
Sub classification
Health Care Financing Administration Common Procedure Coding System
CPT SECTIONS.
Unspecified (hypertension)
32. anterior to the temporal bones.
Performing Provider Identification Number (PPIN)
Sphenoid Bones
Hairline
Pre-certification
33. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
Lipocyte
MEDICARE Part D
Group Provider Number
Health Maintenance Organization (HMO)
34. Is made up of the shoulder - collar - pelvic and arms and legs
Employer Identification Number (EIN)
Capitated Rates
appendicular skeleton .
lunula
35. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Clean claim
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Polyp
Hairline
36. 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
Preferred Provider Organization (PPO)
Impacted
Humerus
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
37. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
co-payment
Peer Review Organization (PRO)
38. death of tissue associated with loss of blood supply
Dirty claim
Unlisted Procedures Procedures
Gangrene
Categorically needy -MEDICAID
39. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Secondary malignancy
ulna
Health Insurance Portability and Accountability Act (HIPAA)
40. 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....
Collagen
Zygoma
Category III Codes CPT
Established patient
41. The lower anterior part of the bone
Vesicle
triangle (a
Medicaid
Pubic bone
42. Is when two insurance companies work together to coordinate payment of the benefits.
The Good Samaritan Act
TRICARE
Contracted Rates with MCOs
Coordination of Benefits (COB)
43. is a traumatic injury to a joint involving the soft tissue.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Employer Liability
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
sprain
44. Are composed of three-digit codes representing a single disease or condition.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
The Current Procedural Terminology (CPT)
Medicare
Categories
45. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Unauthorized benefit
Ischium
Column 1/Column 2 (previously called Comprehensive/Component) Edits
There are three layers to the skin
46.
stand-alone codes
Subcategories
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Multigravida
47. the bone is broken and the ends are driven into each other.
Full ROM
Surgical Package
Impacted
triangle (a
48. 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..
true ribs
Musculoskeletal System
-90 - Reference (Outside) Laboratory
Medical necessity
49. 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.
Dirty claim
Compliance Regulations
Physician
-26 - Professional Component
50. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Vomer
Past - family and social history (PFSH)
Social Security Number
Long bones