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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. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Benign (hypertension)
The Good Samaritan Act
circle with a line through it)
premium
2. 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
Sesamoid bones
Accident
False ribs
Relative Value Payment Schedules Method
3. Describes the services billed and includes a breakdown of how the payment is determined
A plus sign (+)
Birthday rule
Explanation of Benefits (EOB)
-90 - Reference (Outside) Laboratory
4. Benign growth extending from the surface of the mucous membrane
Polyp
Mutually Exclusive Edits
New Patient
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
5. 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
Peer Review Organization (PRO)
Salter-Harris
Employer Liability
Personal Insurance
6. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu
Frontal Bone
Impetigo
Neoplasm Table
triangle (a
7. 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
eponychium
Medicare
The St. Anthony Relative Value for Physicians (RVP)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
8. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Flat bones
Palatine bones
False ribs
9. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Ethmoid Bone
Compression fracture
Preferred Provider Organization (PPO)
10. 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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11. 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
Medicare
Clearinghouse
Civil Monetary Penalties Law (CMPL)
Location Methods
12. Lower portion of the pelvic bone
Relative Value Payment Schedules Method
HCPCS Level II codes (National Codes)
Ethmoid Bone
Ischium
13. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Primary malignancy
Review of Systems (ROS)
Comminuted fracture
Category I Codes CPT
14. Typically not used on the claim form unless the provider does not have an EIN.
Impetigo
Social Security Number
Compliance Regulations
Humerus
15. 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
Secondary malignancy
Carcinoma (Ca) in situ
Ulcermembranes
Group Insurance
16. 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
Fee Schedule
co-payment
Salter-Harris
Keratin
17. 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
Flat bones
MEDICARE Part C
HCPCS Level II codes (National Codes)
18. 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.
Patient Confidentiality
Clean claim
Employee Liability
Group Provider Number
19. Is the lateral lower arm bone (in line with the thumb).
Flat bones
Radius
Eligibility
Participating physician
20. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Group Insurance
Impetigo
Malignant
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
21. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
Carpals
MEDICAID COVERAGE
nonessential modifiers
Medically needy
22. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
-50 - Bilateral Procedure
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Parietal Bones
HCPCS Level I codes
23. 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.
Preferred Provider Organization (PPO)
Dirty claim
Compression fracture
Long bones
24. 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.
Medical Records
Employee Liability
Sesamoid bones
Contracted Rates with MCOs
25. Is the qualifying factor or factors that must be met before a patient receives benefits.
Eligibility
The St. Anthony Relative Value for Physicians (RVP)
Sphenoid Bones
phalanges (phalanx.s)
26. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
The Patient Care Partnership (Patient's Bill of Rights)
Unauthorized benefit
Impetigo
Coordination of Benefits (COB)
27. 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.
Categorically needy -MEDICAID
Multigravida
Established Patient
Benign
28. Poisoning cannot be determined whether intentional or accidental.
Undetermined
TRICARE PLANS
upper appendicular skeleton
Modifiers
29. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Humerus
Group Provider Number
Wheal
Modifiers
30. Is the qualifying factor or factors that must be met before a patient receives benefits.
Eligibility
Patient Confidentiality
Reasons for Documentation
ulna
31. 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.
Medical necessity
A plus sign (+)
Mutually Exclusive Edits
phalanges (phalanx.s)
32. Represent changes in the text or definition between the triangles.
Two triangular symbols (a
State License Number
Peer Review Organization (PRO)
Coordination of Benefits (COB)
33. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Indemnity Insurance
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Peer Review Organization (PRO)
Unlisted Procedures Procedures
34. forms the two lower sides of the cranium.
Provider Identification Number (PIN)
Category III Codes CPT
Temporal Bone
Zygoma
35. Most billing-related cases are based on HIPAA and False Claims Act.
Commercial Carriers
Compliance Regulations
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
ligaments
36. Cheekbone
Unspecified (hypertension)
upper appendicular skeleton
Hypertension Table
Zygoma
37. 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
circle with a line through it)
Gangrene
Abuse
Fee-for-Service
38. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
-50 - Bilateral Procedure
HCPCS Level II codes (National Codes)
Pre-paid Health Plan
Accept assignment
39. 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)
Pre-paid Health Plan
Impacted
Liability insurance
40. major skin pigment
Melanin
Nodule
Unauthorized benefit
Section 3 Index to External Causes of Injury (E codes)
41. 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
HCPCS Level II codes (National Codes)
Coinsurance
Carpals
Parietal Bones
42. Structural protein found in the skin and connective tissue
There are two types of sweat glands
A plus sign (+)
Collagen
MEDICARE Part B
43.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Malignant
Neoplasm Table
Sebaceous glands
44. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Unauthorized benefit
Commercial Carriers
Chief complaint
circle with a line through it)
45. 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
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Category I Codes CPT
Coinsurance
Keratin
46. 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
False ribs
Employer Liability
Liability insurance
47. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Radius
Hairline
Wheal
There are three layers to the skin
48. Is when two insurance companies work together to coordinate payment of the benefits.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Coordination of Benefits (COB)
HCPCS Level II codes (National Codes)
Accident
49. This modifier is used when the same procedure is performed on a mirror-image part of the body..
-50 - Bilateral Procedure
Indemnity Insurance
Lacrimal bones
The St. Anthony Relative Value for Physicians (RVP)
50. 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
Spinal/Vertebral Column
Group Provider Number
Dirty claim
Non-covered benefit