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Test your basic knowledge |
Medical Billing And Coding Vocab
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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 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.
Humerus
Pelvis
The Integumentary System
Group practice
2. 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
False Claims Act (FCA)
The Integumentary System
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Civil Monetary Penalties Law (CMPL)
3. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
encounter form
Unique Provider Identification Number (UPIN)
Performing Provider Identification Number (PPIN)
4. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
Chief complaint (CC)
Modifiers
Salter-Harris
5. 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
Ethmoid Bone
Ulcermembranes
Advance Beneficiary Notice
6. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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7. 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
Coordination of Benefits (COB)
Consultation
TRICARE
Dirty claim
8. Represents a new procedure or service code added since the previous edition of the manual.
Melanin
-90 - Reference (Outside) Laboratory
Sections
bullet (a
9. Groove or crack like sore
Health practitioner
Wheal
Fissure
Compliance Regulations
10. 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
MEDICARE Part C
Relative Value Payment Schedules Method
Medical Records
Carpals
11. Further classified as to primary - secondary - or carcinoma in situ.
Humerus
Category II Codes CPT
Malignant
The Universal Claim Form
12. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Categories
Non-covered benefit
MEDICARE Part A
Full ROM
13. Noninvasive - non-spreading - nonmalignant
Outpatient
Remittance Advice
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Benign
14. 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.
Multigravida
Long bones
Non-covered benefit
Sphenoid Bones
15. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Mutually Exclusive Edits
Explanation of Benefits (EOB)
Paper Claim
The Good Samaritan Act
16. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
Hairline
Unspecified (hypertension)
Civil Monetary Penalties Law (CMPL)
MEDICARE Part B
17. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Electronic Claim
Sub classification
Deductible
itemized statement
18. The fractured area of bone collapses on itself.
A plus sign (+)
The Patient Care Partnership (Patient's Bill of Rights)
Compression fracture
The Patient Care Partnership (Patient's Bill of Rights)
19. The reason the patient came to see the physician.
MEDICAID COVERAGE
Accident
Modifiers
Chief complaint (CC)
20. Upper jaw bone
Maxilla
Medical necessity
Patient Confidentiality
itemized statement
21. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
No ROM
eponychium
Group practice
False Claims Act (FCA)
22. 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
Social Security Number
Pelvis
Unlisted Procedures Procedures
Group Insurance
23. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve
Accident
New Patient
False ribs
appendicular skeleton .
24. Make up part of the interior of the nose.
The St. Anthony Relative Value for Physicians (RVP)
Rib Cage
Inferior nasal conchae
Malignant
25. 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.
MEDICARE Part B
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Add-on codes
Group Insurance
26. Upper jaw bone
Maxilla
Impacted
Disability insurance
Paper Claim
27. Most billing-related cases are based on HIPAA and False Claims Act.
Spinal/Vertebral Column
bullet (a
Group practice
Compliance Regulations
28. Deficient in pigment (melanin)
Medigap (Medicare Supplemental Insurance)
Flat bones
Contracted Rates with MCOs
Albino
29. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Uncertain behavior
Category III Codes CPT
Primary malignancy
The Integumentary System
30. 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.
Hairline
MEDICARE Part D
Category III Codes CPT
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
31. A pregnant woman who has had at least one previous pregnancy.
Multigravida
Accident
Sphenoid Bones
Unspecified nature
32. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.
History of present illness (HPI)
Inpatient
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Reasons for Documentation
33. 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
Civil Monetary Penalties Law (CMPL)
Accident
Medicare Claim Status
34. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H
TRICARE
Unauthorized benefit
Colles
Inpatient
35. 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.
Benign (hypertension)
itemized statement
Comminuted fracture
-99 - Multiple Modifiers
36. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
Capitated Rates
Malignant
Impetigo
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
37. Poisoning cannot be determined whether intentional or accidental.
Neoplasm Table
Physician
Undetermined
TRICARE PLANS
38. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Greenstick
Pathologic
Ulcermembranes
Carcinoma (Ca) in situ
39. 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
Health Maintenance Organization (HMO)
Long bones
Fee-for-Service
TRICARE
40. Superior and widest bone
Pelvis
Preferred Provider Organization (PPO)
Remittance Advice
Patient Confidentiality
41. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
HCPCS Level I codes
Advance Beneficiary Notice
MEDICARE Part A
Liability insurance
42. are small with irregular shapes. They are found in the wrist and ankle.
Disability insurance
Rejected claim
New Patient
Short bones
43. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
Clearinghouse
-99 - Multiple Modifiers
appendicular skeleton .
Lipocyte
44. 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
Pelvis
Health Maintenance Organization (HMO)
Location Methods
No ROM
45. The fractured area of bone collapses on itself.
Short bones
Compression fracture
Ischium
phalanges (phalanx.s)
46. 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
Add-on codes
State License Number
circle with a line through it)
Past - family and social history (PFSH)
47. The moon like white area at the base of the nail.
Modifiers
lunula
Retention of Medical Records
Electronic Claim
48. 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
Commercial Carriers
Modifiers
Undetermined
Paper Claim
49. 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.
Fiscal Intermediary
Non-covered benefit
Workers Compensation
Explanation of Benefits (EOB)
50. Is the upper arm bone.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Humerus
The Universal Claim Form
Qualified diagnosis
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