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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. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Lipocyte
Undetermined
2. Is the lateral lower arm bone (in line with the thumb).
Parietal Bones
Coordination of Benefits (COB)
Modifiers
Radius
3. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
HCPCS Level I codes
Past - family and social history (PFSH)
The Good Samaritan Act
Health Insurance Portability and Accountability Act (HIPAA)
4. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Ethmoid Bone
A plus sign (+)
Pre-certification
Column 1/Column 2 (previously called Comprehensive/Component) Edits
5. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Hypertension Table
Established Patient
-51 - Multiple Procedures
6. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Full ROM
sebaceous(oil) glands and the suddoriferous (sweat) glands
Alopecia
7. The moon like white area at the base of the nail.
Pubic bone
New Patient
lunula
History
8. The physician must obtain this number in order to practice within a state.
State License Number
The Good Samaritan Act
Group Provider Number
Parietal Bones
9. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
False Claims Act (FCA)
Unlisted Procedures Procedures
Compression fracture
ligaments
10. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Alopecia
Full ROM
Pubic bone
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
11. 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
Assault
Benign (hypertension)
TRICARE
Location Methods
12. Is made up of the shoulder - collar - pelvic and arms and legs
Medicaid
Subcategories
appendicular skeleton .
New patient
13. 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:
Reasons for Documentation
Hypertension Table
The St. Anthony Relative Value for Physicians (RVP)
Gender rule
14. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages
Clearinghouse
Advance Beneficiary Notice
Liability insurance
Ischium
15. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
Accident
Group practice
Spinal/Vertebral Column
16. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
nonessential modifiers
HCPCS Level I codes
Long bones
Unique Provider Identification Number (UPIN)
17. 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
Sebaceous glands
Categorically needy -MEDICAID
Electronic Claim
Coinsurance
18. 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.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Birthday rule
New Patient
Group practice
19. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Clean claim
Keratin
HCPCS Level II codes (National Codes)
20. 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.
Chapters
Pre-paid Health Plan
Impacted
National Correct Coding Initiative (NCCI)
21. 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.
Fee-for-Service
New patient
The Universal Claim Form
Mandible
22. Number assigned by the insurance company to a physician who renders services to patients.
Fee Schedule
Provider Identification Number (PIN)
Flat bones
CPT SECTIONS.
23. The reason the patient came to see the physician.
Coding
appendicular skeleton .
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Chief complaint (CC)
24. 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
Benign
Electronic Claim
There are three layers to the skin
25. Upper jaw bone
The Patient Care Partnership (Patient's Bill of Rights)
Medically needy
Suicide Attempt
Maxilla
26. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Alphabetic Index (Volume 2)
Colles
Rejected claim
Malignant
27. 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
Fee-for-Service
Accident
Unspecified nature
Colles
28. 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.
Pre-determination
CPT SECTIONS.
Nodule
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
29. Lower portion of the pelvic bone
Impetigo
Ischium
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Employer Liability
30. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Undetermined
CPT SECTIONS.
Maxilla
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
31. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Fee-for-Service
Sesamoid bones
New Patient
Comminuted fracture
32. Deficient in pigment (melanin)
Birthday rule
Unlisted Procedures Procedures
Albino
Greenstick
33. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
-90 - Reference (Outside) Laboratory
sebaceous(oil) glands and the suddoriferous (sweat) glands
Melanin
Modifiers
34. 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
-51 - Multiple Procedures
Point-of-Service plan (POS)
Frontal Bone
A plus sign (+)
35. 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
Lipocyte
Abuse
Macule
MEDICARE Part D
36. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Pre-certification
Polyp
Point-of-Service plan (POS)
Disability insurance
37. 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
Humerus
Melanin
Health practitioner
MEDICARE Part C
38. Contains complete - necessary information - but is incorrect or illogical in some way.
Past - family and social history (PFSH)
Personal Insurance
Invalid claim
Peer Review Organization (PRO)
39. the bone is crushed and or shattered.
Nodule
Comminuted fracture
Medicare
Nonparticipating physician
40. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Complicated
Surgical Package
Employer Identification Number (EIN)
Invalid claim
41. 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
Suicide Attempt
Consultation
Blue Cross/Blue Shield Plans
42. Mild or controlled hypertension and no damage to the vascular system or organs.
Benign (hypertension)
MEDICARE Part D
Electronic Claim
Tabular List (Volume 1)...
43. Numbers 1-7 - attach directly to the sternum in the front of the body.
History of present illness (HPI)
The Patient Care Partnership (Patient's Bill of Rights)
ligaments
true ribs
44. 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.
Parietal Bones
Birthday rule
Category II Codes CPT
Health Maintenance Organization (HMO)
45. 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
-99 - Multiple Modifiers
Full ROM
Workers Compensation
axial skeleton
46. uncertain whether benign or malignant; borderline malignancy
Chapters
Uncertain behavior
Subcategories
New Patient
47. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
Impacted
Nodule
Evaluation and Management Review
Deductible
48. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
-32 - Mandated Services
Sebaceous glands
Health Insurance Portability and Accountability Act (HIPAA)
Chief complaint (CC)
49. 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.
Health Care Financing Administration Common Procedure Coding System
circle with a line through it)
Consultation
Category III Codes CPT
50. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
circle with a line through it)
Mutually Exclusive Edits
Gangrene
-26 - Professional Component