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Test your basic knowledge |
Medical Billing And Coding Vocab
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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. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
Secondary malignancy
Occipital Bone
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Impetigo
2. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Explanation of Benefits (EOB)
There are two types of sweat glands
eponychium
Salter-Harris
3. 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.
Pre-determination
Physician
Dirty claim
A plus sign (+)
4. Is an electronic or paper-based report of payment sent by the payer to the provider.
Retention of Medical Records
Remittance Advice
The Integumentary System
Accept assignment
5. The poisoning was self-inflicted.
lunula
Macule
Nodule
Suicide Attempt
6. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
stand-alone codes
HCPCS Level I codes
Rib Cage
Spinal/Vertebral Column
7. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
Unspecified nature
Patient Confidentiality
Medicaid
Invalid claim
8. 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
MEDICARE Part C
Consultation
sprain
Past - family and social history (PFSH)
9. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Modifiers
Sphenoid Bones
Birthday rule
10. 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
New Patient
Established Patient
Consultation
11. poisoning was inflicted by another person with intent to kill or injure
Past - family and social history (PFSH)
Albino
Unspecified (hypertension)
Assault
12. 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.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Fiscal Intermediary
Pre-determination
A plus sign (+)
13. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Inferior nasal conchae
Invalid claim
Malignant
Suicide Attempt
14. Consists of the skull - rib cage - and spine
axial skeleton
Medigap (Medicare Supplemental Insurance)
Alopecia
Modifiers
15. 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.
Physician
Gender rule
true ribs
History
16. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Musculoskeletal System
Short bones
Health Insurance Portability and Accountability Act (HIPAA)
Preferred Provider plan
17. 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.
Mutually Exclusive Edits
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
itemized statement
Category III Codes CPT
18. 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.
Group practice
Location Methods
lunula
Comminuted fracture
19. 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
The Current Procedural Terminology (CPT)
appendicular skeleton .
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Sub classification
20. male of household is primary payer
bullet (a
Clearinghouse
Colles
Gender rule
21. 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
Humerus
Preferred Provider Organization (PPO)
Medically needy
MEDICAID COVERAGE
22. 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.
-32 - Mandated Services
appendicular skeleton .
Comminuted fracture
phalanges (phalanx.s)
23. 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
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Employer Identification Number (EIN)
Clearinghouse
Short bones
24. Absence of hair from areas where it normally grows
Nodule
Alopecia
Category I Codes CPT
-50 - Bilateral Procedure
25. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.
Compression fracture
MEDICARE Part D
Dirty claim
Vesicle
26. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Remittance Advice
Coding
Pre-certification
true ribs
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
There are three layers to the skin
Lipocyte
Unlisted Procedures Procedures
Unique Provider Identification Number (UPIN)
28. 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
Point-of-Service plan (POS)
Chapters
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Alphabetic Index (Volume 2)
29. 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
MEDICARE Part D
Chief complaint (CC)
Benign
Social Security Number
30. 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.
Vomer
Benign (hypertension)
National Correct Coding Initiative (NCCI)
eponychium
31. 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
Temporal Bone
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
There are three layers to the skin
The Current Procedural Terminology (CPT)
32. The fractured area of bone collapses on itself.
Invalid claim
Compression fracture
triangle (a
Location Methods
33. major skin pigment
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Categories
-99 - Multiple Modifiers
Melanin
34. 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.
New Patient
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Ulcermembranes
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
35. Lower portion of the pelvic bone
Impacted
Secondary malignancy
History
Ischium
36. Are composed of three-digit codes representing a single disease or condition.
Categories
Nodule
False ribs
Primary malignancy
37. Is the qualifying factor or factors that must be met before a patient receives benefits.
TRICARE
ligaments
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Eligibility
38. 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.'
Pre-certification
Sebaceous glands
No ROM
Medical necessity
39. 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
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Category III Codes CPT
Birthday rule
History
40. is a traumatic injury to a joint involving the soft tissue.
Unique Provider Identification Number (UPIN)
Hairline
sprain
Eligibility
41. 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
Pathologic
Established Patient
Fee-for-Service
Subcategories
42. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Non-covered benefit
Add-on codes
Unlisted Procedures Procedures
Past - family and social history (PFSH)
43. The bone is broken and pierces an internal organ
Complicated
Past - family and social history (PFSH)
circle with a line through it)
Medicare
44. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
History of present illness (HPI)
Unspecified nature
-50 - Bilateral Procedure
Vomer
45. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
phalanges (phalanx.s)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Workers Compensation
46. 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
Clean claim
Unlisted Procedures Procedures
Inferior nasal conchae
Point-of-Service plan (POS)
47. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
Employer Liability
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Established Patient
48. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Flat bones
Medically needy
Blue Cross/Blue Shield Plans
Preferred Provider plan
49. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
Medical necessity
The St. Anthony Relative Value for Physicians (RVP)
Disability insurance
Past - family and social history (PFSH)
50. 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
Sebaceous glands
Coding
Relative Value Payment Schedules Method
Category II Codes CPT