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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. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
False ribs
Fraud
Medical Records
Review of Systems (ROS)
2. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
HCPCS Level II codes (National Codes)
Preferred Provider plan
Patient Confidentiality
New Patient
3. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Capitated Rates
Full ROM
Gangrene
Ischium
4. 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)
Inferior nasal conchae
Mutually Exclusive Edits
Pathologic
5. Forms the anterior part of the skull and the forehead
Frontal Bone
Coordination of Benefits (COB)
Employer Identification Number (EIN)
Colles
6. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Alopecia
MEDICARE Part A
Established Patient
Carpals
7. Most billing-related cases are based on HIPAA and False Claims Act.
Mutually Exclusive Edits
Compliance Regulations
HCPCS Level I codes
Categories
8. The cuticle at the lower part of the nail and this is sometimes referred to as the
eponychium
Uncertain behavior
bullet (a
Humerus
9. forms the roof of the nasal cavity.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Category III Codes CPT
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Ethmoid Bone
10. solid - round or oval elevated lesion more than 1 cm in diameter
Categorically needy -MEDICAID
Provider Identification Number (PIN)
Medical necessity
Nodule
11. The moon like white area at the base of the nail.
lunula
Patient Confidentiality
Qualified diagnosis
Medical necessity
12. represents Exemption from the use of modifier -51
Liability insurance
Carpals
Occipital Bone
circle with a line through it)
13. 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.
Medicaid
National Correct Coding Initiative (NCCI)
Section 3 Index to External Causes of Injury (E codes)
Employer Liability
14. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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15. 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
Secondary malignancy
Sections
Accident
Comminuted fracture
16. 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.
Health Insurance Portability and Accountability Act (HIPAA)
Employer Identification Number (EIN)
Pre-determination
Parietal Bones
17. 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
Humerus
Neoplasm Table
Collagen
Sebaceous glands
18. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Category I Codes CPT
-51 - Multiple Procedures
Radius
Flat bones
19. Discolored - flat lesion (freckles - tattoo marks)
Macule
Limited ROM
Tabular List (Volume 1)...
Gangrene
20. 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:
Hypertension Table
Social Security Number
premium
Frontal Bone
21. anterior to the temporal bones.
Long bones
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Sphenoid Bones
Uncertain behavior
22. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
History
Pre-authorization
Medical Records
stand-alone codes
23. 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
Compliance Regulations
Health practitioner
Ulcermembranes
Location Methods
24. 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
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Employee Liability
stand-alone codes
-51 - Multiple Procedures
25. 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
Medicaid
Health practitioner
Coinsurance
There are two types of sweat glands
26. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
nonessential modifiers
Accept assignment
Albino
HCPCS Level I codes
27. 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.
itemized statement
New patient
Workers Compensation
Blue Cross/Blue Shield Plans
28. Is the qualifying factor or factors that must be met before a patient receives benefits.
Employee Liability
Eligibility
sebaceous(oil) glands and the suddoriferous (sweat) glands
Collagen
29. 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
-32 - Mandated Services
Medigap (Medicare Supplemental Insurance)
Retention of Medical Records
Unlisted Procedures Procedures
30. This is not specified as benign or malignant in the diagnosis or medical record.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Unspecified (hypertension)
Carpals
Category I Codes CPT
31. 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
Pre-authorization
Impetigo
Fissure
Fee Schedule
32. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Malignant
Clearinghouse
MEDICARE Part C
33. Typically not used on the claim form unless the provider does not have an EIN.
Ischium
Social Security Number
Tabular List (Volume 1)...
Flat bones
34. poisoning was inflicted by another person with intent to kill or injure
Primary malignancy
Assault
Modifiers
Clearinghouse
35. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
axial skeleton
The Integumentary System
There are two types of sweat glands
Fiscal Intermediary
36. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Category I Codes CPT
Ethmoid Bone
Medicare
New Patient
37. 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
Reasons for Documentation
Section 3 Index to External Causes of Injury (E codes)
Accept assignment
CPT SECTIONS.
38. Pre-determined set of benefits covered under one set annual fee.
Pre-paid Health Plan
nonessential modifiers
-50 - Bilateral Procedure
Coinsurance
39. 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.
Carpals
Lacrimal bones
Performing Provider Identification Number (PPIN)
Sesamoid bones
40. paired bones at the corner of each eye that cradle the tear ducts.
The Current Procedural Terminology (CPT)
Employee Liability
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Lacrimal bones
41. Forms the sides of the cranium
Parietal Bones
Consultation
Chief complaint (CC)
Location Methods
42. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
State License Number
Consultation
Coding
Long bones
43. 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
Clearinghouse
axial skeleton
History of present illness (HPI)
Primary malignancy
44. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Fee-for-Service
Contracted Rates with MCOs
Category III Codes CPT
45. 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
stand-alone codes
TRICARE PLANS
Gangrene
Birthday rule
46. numbers 8-10 - are attached to the sternum by cartilage
Physician
Categories
Malignant
False ribs
47. Contains complete - necessary information - but is incorrect or illogical in some way.
Eligibility
Invalid claim
Frontal Bone
Health Maintenance Organization (HMO)
48. The fractured area of bone collapses on itself.
circle with a line through it)
Compression fracture
Capitated Rates
Employee Liability
49. Cheekbone
Zygoma
Unspecified nature
Coding
Neoplasm Table
50. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Category II Codes CPT
Malignant
Hairline
Musculoskeletal System