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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. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Assault
Keratin
Explanation of Benefits (EOB)
-50 - Bilateral Procedure
2. 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
Non-covered benefit
Fee Schedule
Vesicle
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
3. Forms the anterior part of the skull and the forehead
Mandible
Undetermined
Frontal Bone
Blue Cross/Blue Shield Plans
4. anterior to the temporal bones.
Sphenoid Bones
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Parietal Bones
sprain
5. Groove or crack like sore
premium
Past - family and social history (PFSH)
Inpatient
Fissure
6. Indicates add-on codes
New Patient
History
A plus sign (+)
The Integumentary System
7. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Civil Monetary Penalties Law (CMPL)
Benign
Contracted Rates with MCOs
Modifiers
8. 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.
Mandible
Medigap (Medicare Supplemental Insurance)
Pre-determination
Fiscal Intermediary
9. 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
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Capitated Rates
The Integumentary System
Lipocyte
10. Typically not used on the claim form unless the provider does not have an EIN.
MEDICARE Part C
Nodule
Social Security Number
Review of Systems (ROS)
11. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
Long bones
The St. Anthony Relative Value for Physicians (RVP)
Ethmoid Bone
New patient
12. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
Qualified diagnosis
Peer Review Organization (PRO)
Chief complaint
13. 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.
Comminuted fracture
Remittance Advice
National Correct Coding Initiative (NCCI)
The Current Procedural Terminology (CPT)
14. male of household is primary payer
Gender rule
Compliance Regulations
Point-of-Service plan (POS)
Location Methods
15. 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
ligaments
stand-alone codes
-99 - Multiple Modifiers
Rejected claim
16. 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.
MEDICARE Part C
HCPCS Level I codes
eponychium
phalanges (phalanx.s)
17. Absence of hair from areas where it normally grows
Relative Value Payment Schedules Method
Alopecia
Alphabetic Index (Volume 2)
National Correct Coding Initiative (NCCI)
18. 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.
-99 - Multiple Modifiers
Section 3 Index to External Causes of Injury (E codes)
Short bones
Non-covered benefit
19. 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.
Melanin
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
phalanges (phalanx.s)
There are two types of sweat glands
20. Further classified as to primary - secondary - or carcinoma in situ.
Mutually Exclusive Edits
Pre-authorization
Malignant
nonessential modifiers
21. Is the lower medial arm bone.
Malignant
Rib Cage
Column 1/Column 2 (previously called Comprehensive/Component) Edits
ulna
22. the bone is broken and the ends are driven into each other.
-26 - Professional Component
Clearinghouse
Civil Monetary Penalties Law (CMPL)
Impacted
23. 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
Pre-paid Health Plan
Patient Confidentiality
Rib Cage
24. major skin pigment
Suicide Attempt
Mutually Exclusive Edits
The Integumentary System
Melanin
25. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
-32 - Mandated Services
Peer Review Organization (PRO)
No ROM
stand-alone codes
26. 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
Pathologic
MEDICARE Part C
Nodule
Fiscal Intermediary
27. Small collection of clear fluid;blister
Invalid claim
Unauthorized benefit
Vesicle
Retention of Medical Records
28. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Compression fracture
Category II Codes CPT
Multigravida
Carcinoma (Ca) in situ
29. 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.
Evaluation and Management Review
itemized statement
Coordination of Benefits (COB)
Clean claim
30. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
phalanges (phalanx.s)
Limited ROM
Indemnity Insurance
lunula
31. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
encounter form
Sphenoid Bones
Suicide Attempt
Alopecia
32. 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 -
TRICARE PLANS
Coinsurance
Add-on codes
essential modifiers
33. 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.
Frontal Bone
New patient
Liability insurance
phalanges (phalanx.s)
34. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Consultation
Rib Cage
Modifiers
35. 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.
Explanation of Benefits (EOB)
premium
Medical Records
Participating physician
36. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Pre-determination
sprain
There are two types of sweat glands
Electronic Claim
37. Produce secretions that allow the body to be moisturized or cooled.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Invalid claim
False Claims Act (FCA)
Mutually Exclusive Edits
38. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
Medicare Claim Status
Short bones
Occipital Bone
Surgical Package
39. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Long bones
Hairline
False Claims Act (FCA)
There are three layers to the skin
40. 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
Carcinoma (Ca) in situ
Participating physician
Peer Review Organization (PRO)
MEDICARE Part D
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.
Ethmoid Bone
Category II Codes CPT
No ROM
Secondary malignancy
42. 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
Carpals
Retention of Medical Records
Paper Claim
ligaments
43. Forms the anterior part of the skull and the forehead
HCPCS Level I codes
Unique Provider Identification Number (UPIN)
Remittance Advice
Frontal Bone
44. Indicates add-on codes
Humerus
A plus sign (+)
Vomer
Patient Confidentiality
45. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Contracted Rates with MCOs
Carcinoma (Ca) in situ
Nonparticipating physician
Medically needy
46. Is when two insurance companies work together to coordinate payment of the benefits.
Dirty claim
Coordination of Benefits (COB)
encounter form
Pelvis
47. the bone is broken and the ends are driven into each other.
Contracted Rates with MCOs
Radius
Group Provider Number
Impacted
48. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Coding
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Maxilla
MEDICAID COVERAGE
49. A fat cell
Occipital Bone
MEDICARE Part A
Pre-paid Health Plan
Lipocyte
50. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Radius
Hypertension Table
Impetigo
HCPCS Level I codes