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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.
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. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual
Relative Value Payment Schedules Method
MEDICARE Part A
Fee Schedule
lunula
2. requires investigation and needs further clarification.
Fee-for-Service
Tabular List (Volume 1)...
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Rejected claim
3. Indicates add-on codes
A plus sign (+)
Hypertension Table
nonessential modifiers
Macule
4. 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
The Patient Care Partnership (Patient's Bill of Rights)
Undetermined
Capitated Rates
Long bones
5. the bone is crushed and or shattered.
Comminuted fracture
Employee Liability
Medical necessity
Benign (hypertension)
6. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
CPT SECTIONS.
Medically needy
A plus sign (+)
Point-of-Service plan (POS)
7. 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.
Outpatient
Inpatient
stand-alone codes
MEDICARE Part A
8. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
New patient
stand-alone codes
Categorically needy -MEDICAID
Surgical Package
9. 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
Chief complaint
Category I Codes CPT
Salter-Harris
Workers Compensation
10. are small with irregular shapes. They are found in the wrist and ankle.
Deductible
Categories
Employer Identification Number (EIN)
Short bones
11. is a traumatic injury to a joint involving the soft tissue.
Consultation
Suicide Attempt
sprain
Provider Identification Number (PIN)
12. 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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13. anterior to the temporal bones.
Sphenoid Bones
Eligibility
Chief complaint
History
14. A fat cell
MEDICARE Part D
Neoplasm Table
Lipocyte
Chief complaint
15. 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:
Spinal/Vertebral Column
Secondary malignancy
Category II Codes CPT
Hypertension Table
16. 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.
Dirty claim
Disability insurance
Medicaid
Column 1/Column 2 (previously called Comprehensive/Component) Edits
17. 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
MEDICARE Part B
Medicaid
Established Patient
History of present illness (HPI)
18. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Employer Identification Number (EIN)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Reasons for Documentation
true ribs
19. 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.
Exclusions and Limitations
Non-covered benefit
Medicaid
Coinsurance
20. The physician must obtain this number in order to practice within a state.
-99 - Multiple Modifiers
Multigravida
State License Number
-32 - Mandated Services
21. 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
stand-alone codes
Employer Liability
HCPCS Level II codes (National Codes)
sprain
22. 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.
National Correct Coding Initiative (NCCI)
Keratin
Surgical Package
Reasons for Documentation
23. This is the inventory of the constitutional symptoms regarding the various body systems.
Sesamoid bones
Review of Systems (ROS)
State License Number
Comminuted fracture
24. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Spinal/Vertebral Column
Pre-certification
Exclusions and Limitations
National Correct Coding Initiative (NCCI)
25. 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.
Pre-authorization
Health Care Financing Administration Common Procedure Coding System
essential modifiers
Performing Provider Identification Number (PPIN)
26. Typically not used on the claim form unless the provider does not have an EIN.
Social Security Number
Medical necessity
-50 - Bilateral Procedure
Health Insurance Portability and Accountability Act (HIPAA)
27. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Chief complaint (CC)
Advance Beneficiary Notice
Non-covered benefit
Group Provider Number
28. The moon like white area at the base of the nail.
-51 - Multiple Procedures
Keratin
upper appendicular skeleton
lunula
29. 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
axial skeleton
Capitated Rates
Medically needy
30. Deficient in pigment (melanin)
The Good Samaritan Act
Benign (hypertension)
Albino
MEDICARE Part A
31. 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 Insurance
Group practice
Commercial Carriers
Paper Claim
32. Number assigned by the insurance company to a physician who renders services to patients.
Pathologic
Maxilla
Provider Identification Number (PIN)
Macule
33. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Tabular List (Volume 1)...
Outpatient
HCPCS Level I codes
Musculoskeletal System
34. 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)
Dirty claim
co-payment
A plus sign (+)
False ribs
35. Any fracture occurring spontaneously as a result of disease.
Remittance Advice
Melanin
Qualified diagnosis
Pathologic
36. The fractured area of bone collapses on itself.
Albino
essential modifiers
Musculoskeletal System
Compression fracture
37. Cheekbone
Zygoma
Relative Value Payment Schedules Method
Unauthorized benefit
Two triangular symbols (a
38. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Malignant
Keratin
stand-alone codes
Abuse
39. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Flat bones
Ulcermembranes
lunula
Rib Cage
40. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Pubic bone
Workers Compensation
axial skeleton
Chapters
41. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Mandible
Full ROM
Unspecified nature
premium
42. Is one who has no contract with the health insurance plan.
Medical necessity
Nonparticipating physician
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Carcinoma (Ca) in situ
43. 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
New patient
Lacrimal bones
Remittance Advice
44. 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
Location Methods
Health practitioner
-90 - Reference (Outside) Laboratory
Alphabetic Index (Volume 2)
45. 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
Paper Claim
Coinsurance
Polyp
MEDICARE Part C
46. Represent changes in the text or definition between the triangles.
Spinal/Vertebral Column
Alopecia
Collagen
Two triangular symbols (a
47. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Nodule
Accept assignment
premium
Radius
48. 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.
Add-on codes
Liability insurance
Personal Insurance
Benign
49. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Group Provider Number
Social Security Number
Unique Provider Identification Number (UPIN)
Unspecified nature
50. Small collection of clear fluid;blister
The Patient Care Partnership (Patient's Bill of Rights)
Vesicle
New patient
Non-covered benefit