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Test your basic knowledge |
Medical Billing And Coding Vocab
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medical-transcription
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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. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
Blue Cross/Blue Shield Plans
bullet (a
Electronic Claim
The Universal Claim Form
2. 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.
Neoplasm Table
Group Provider Number
Relative Value Payment Schedules Method
itemized statement
3. 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:
Medical necessity
Fraud
Impacted
Hypertension Table
4. Benign growth extending from the surface of the mucous membrane
ligaments
Invalid claim
Polyp
Established Patient
5. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
Lipocyte
Compression fracture
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Fee-for-Service
6. The bone is broken and pierces an internal organ
Sections
TRICARE
Complicated
Physician
7. major skin pigment
Melanin
The Good Samaritan Act
Reasons for Documentation
New patient
8. 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
Explanation of Benefits (EOB)
MEDICARE Part D
Unspecified nature
Group practice
9. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Reasons for Documentation
Deductible
CPT SECTIONS.
Pubic bone
10. 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
Exclusions and Limitations
TRICARE
Melanin
Multigravida
11. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -
Explanation of Benefits (EOB)
bullet (a
essential modifiers
Invalid claim
12. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
Performing Provider Identification Number (PPIN)
Relative Value Payment Schedules Method
Contracted Rates with MCOs
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
13. Structural protein found in the skin and connective tissue
Group Provider Number
Long bones
Collagen
Point-of-Service plan (POS)
14. 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.
Palatine bones
Category I Codes CPT
Rib Cage
Add-on codes
15. major skin pigment
Melanin
Personal Insurance
The Good Samaritan Act
False ribs
16. represents Exemption from the use of modifier -51
circle with a line through it)
Humerus
Maxilla
Indemnity Insurance
17. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
History of present illness (HPI)
Alphabetic Index (Volume 2)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Sub classification
18. the bone is broken and the ends are driven into each other.
Impacted
Frontal Bone
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Liability insurance
19. Deficient in pigment (melanin)
MEDICARE Part C
Pelvis
appendicular skeleton .
Albino
20. A pregnant woman who has had at least one previous pregnancy.
Unspecified nature
Multigravida
Point-of-Service plan (POS)
Health Insurance Portability and Accountability Act (HIPAA)
21. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
encounter form
Carpals
Employer Identification Number (EIN)
22. 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.
Workers Compensation
Physician
Short bones
There are three layers to the skin
23. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
History of present illness (HPI)
circle with a line through it)
False Claims Act (FCA)
HCPCS Level II codes (National Codes)
24. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Rejected claim
Hypertension Table
Established patient
25. 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)
co-payment
Category I Codes CPT
-51 - Multiple Procedures
Benign
26. 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.
Ethmoid Bone
Advance Beneficiary Notice
Flat bones
axial skeleton
27. 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)
Unlisted Procedures Procedures
Modifiers
Health Maintenance Organization (HMO)
28. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
There are three layers to the skin
ulna
Accident
stand-alone codes
29. The cuticle at the lower part of the nail and this is sometimes referred to as the
Nonparticipating physician
Personal Insurance
eponychium
Parietal Bones
30. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Medicare
Musculoskeletal System
The Current Procedural Terminology (CPT)
Pathologic
31. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).
Fiscal Intermediary
Sections
Category II Codes CPT
Surgical Package
32. Groove or crack like sore
Hairline
Polyp
Qualified diagnosis
Fissure
33. A fat cell
Lipocyte
itemized statement
False ribs
Melanin
34. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Malignant
Long bones
Established Patient
premium
35. most synarthroses are immovable joints held together by fibrous tissue.
-51 - Multiple Procedures
No ROM
State License Number
Sebaceous glands
36. 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
Point-of-Service plan (POS)
Neoplasm Table
Location Methods
Salter-Harris
37. forms the roof of the nasal cavity.
Ethmoid Bone
Category II Codes CPT
Pre-certification
A plus sign (+)
38. Is the lower medial arm bone.
Retention of Medical Records
Physician
ulna
Categories
39. 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
Fee-for-Service
Birthday rule
Capitated Rates
Past - family and social history (PFSH)
40. 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
Coding
Compression fracture
Two triangular symbols (a
Workers Compensation
41. .. lower jaw bone.
Inferior nasal conchae
Review of Systems (ROS)
Group Provider Number
Mandible
42. 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.
Frontal Bone
National Correct Coding Initiative (NCCI)
Inpatient
Explanation of Benefits (EOB)
43. 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
nonessential modifiers
premium
Accident
Health Maintenance Organization (HMO)
44. 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
TRICARE PLANS
MEDICAID COVERAGE
ulna
Add-on codes
45. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Mandible
Categorically needy -MEDICAID
Hairline
Carcinoma (Ca) in situ
46. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.
Point-of-Service plan (POS)
Sections
Preferred Provider plan
Rejected claim
47. 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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48. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Fraud
Malignant
New patient
Sebaceous glands
49. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Malignant
Outpatient
The St. Anthony Relative Value for Physicians (RVP)
bullet (a
50. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Abuse
The Current Procedural Terminology (CPT)
Nodule
itemized statement
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