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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.
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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 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
Impacted
Hypertension Table
Relative Value Payment Schedules Method
Medical Records
2. 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
Short bones
Coinsurance
Point-of-Service plan (POS)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
3. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
Category III Codes CPT
National Correct Coding Initiative (NCCI)
-99 - Multiple Modifiers
4. Number assigned to the physician by Medicare program.
Consultation
Spinal/Vertebral Column
Category II Codes CPT
Unique Provider Identification Number (UPIN)
5. Small collection of clear fluid;blister
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
lunula
Vesicle
Established Patient
6. Typically not used on the claim form unless the provider does not have an EIN.
-99 - Multiple Modifiers
Social Security Number
Add-on codes
Indemnity Insurance
7. Is when two insurance companies work together to coordinate payment of the benefits.
Sphenoid Bones
Location Methods
Coordination of Benefits (COB)
Parietal Bones
8. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Deductible
Pre-paid Health Plan
Relative Value Payment Schedules Method
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
9. Is an electronic or paper-based report of payment sent by the payer to the provider.
National Correct Coding Initiative (NCCI)
Patient Confidentiality
Remittance Advice
Explanation of Benefits (EOB)
10. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Capitated Rates
nonessential modifiers
Radius
11. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
co-payment
History of present illness (HPI)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
axial skeleton
12. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Point-of-Service plan (POS)
Employer Liability
Fiscal Intermediary
Categories
13. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
The Current Procedural Terminology (CPT)
Inpatient
Medical Records
Peer Review Organization (PRO)
14. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
Gangrene
Medical necessity
Albino
False Claims Act (FCA)
15. 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.
MEDICARE Part C
Non-covered benefit
itemized statement
No ROM
16. 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....
The Integumentary System
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Medical Records
The St. Anthony Relative Value for Physicians (RVP)
17. This is the inventory of the constitutional symptoms regarding the various body systems.
Gender rule
-50 - Bilateral Procedure
Chief complaint (CC)
Review of Systems (ROS)
18. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.
Outpatient
Physician
Uncertain behavior
Retention of Medical Records
19. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Chapters
Ischium
Accident
Unlisted Procedures Procedures
20. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.
Musculoskeletal System
Retention of Medical Records
Civil Monetary Penalties Law (CMPL)
Category II Codes CPT
21. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
MEDICARE Part C
Group Insurance
History of present illness (HPI)
Medicare Claim Status
22. represents Exemption from the use of modifier -51
circle with a line through it)
Sebaceous glands
Paper Claim
HCPCS Level I codes
23. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
nonessential modifiers
Outpatient
Impacted
The Integumentary System
24. the bone is crushed and or shattered.
New patient
Comminuted fracture
-32 - Mandated Services
Impacted
25. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Blue Cross/Blue Shield Plans
MEDICARE Part A
Capitated Rates
Sebaceous glands
26. 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.
Pre-authorization
Mutually Exclusive Edits
Sesamoid bones
Established Patient
27. Is one who has no contract with the health insurance plan.
Nonparticipating physician
New patient
Frontal Bone
Malignant
28. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Carcinoma (Ca) in situ
Group Insurance
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Capitated Rates
29. The moon like white area at the base of the nail.
lunula
Social Security Number
Colles
Dirty claim
30. Upper jaw bone
Sebaceous glands
Capitated Rates
Birthday rule
Maxilla
31. Groove or crack like sore
False Claims Act (FCA)
Assault
Mandible
Fissure
32. 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 -
Group practice
Indemnity Insurance
History
Patient Confidentiality
33. Superior and widest bone
co-payment
Coordination of Benefits (COB)
Pelvis
Collagen
34. 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
Health practitioner
Categorically needy -MEDICAID
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Retention of Medical Records
35. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Unique Provider Identification Number (UPIN)
Undetermined
Employee Liability
Coding
36. 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
Coinsurance
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Medicare Claim Status
Secondary malignancy
37. Is the lateral lower arm bone (in line with the thumb).
Benign (hypertension)
-26 - Professional Component
Radius
sebaceous(oil) glands and the suddoriferous (sweat) glands
38. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Pre-certification
Pelvis
-90 - Reference (Outside) Laboratory
Assault
39. 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.
Colles
triangle (a
Remittance Advice
Performing Provider Identification Number (PPIN)
40. Upper jaw bone
Rib Cage
Maxilla
Health practitioner
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
41. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Contracted Rates with MCOs
Relative Value Payment Schedules Method
premium
Pre-authorization
42. Represent changes in the text or definition between the triangles.
Two triangular symbols (a
Performing Provider Identification Number (PPIN)
Occipital Bone
Health Maintenance Organization (HMO)
43. The moon like white area at the base of the nail.
lunula
Health Maintenance Organization (HMO)
Fissure
Carpals
44. Forms the anterior part of the skull and the forehead
Pelvis
Employer Identification Number (EIN)
Mutually Exclusive Edits
Frontal Bone
45. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Surgical Package
Carcinoma (Ca) in situ
Electronic Claim
Contracted Rates with MCOs
46. Mild or controlled hypertension and no damage to the vascular system or organs.
Health Insurance Portability and Accountability Act (HIPAA)
ligaments
Benign (hypertension)
Carpals
47. Is the upper arm bone.
Humerus
The Current Procedural Terminology (CPT)
History of present illness (HPI)
eponychium
48. Is one who has no contract with the health insurance plan.
Assault
Nonparticipating physician
Patient Confidentiality
Humerus
49. .. lower jaw bone.
Mandible
Benign (hypertension)
Past - family and social history (PFSH)
Salter-Harris
50. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
Location Methods
Suicide Attempt
Disability insurance
Birthday rule