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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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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. open sore on the skin or mucous
Benign (hypertension)
Ulcermembranes
Unlisted Procedures Procedures
Flat bones
2. 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
Nonparticipating physician
Multigravida
MEDICARE Part C
Fee Schedule
3. is a traumatic injury to a joint involving the soft tissue.
sprain
New Patient
-99 - Multiple Modifiers
Fee Schedule
4. 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
Birthday rule
Personal Insurance
Unspecified nature
Sub classification
5. 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.
Provider Identification Number (PIN)
Secondary malignancy
Two triangular symbols (a
Physician
6. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Humerus
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Sesamoid bones
Performing Provider Identification Number (PPIN)
7. 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.
Benign (hypertension)
Pelvis
Coordination of Benefits (COB)
Medicare Claim Status
8. 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
Humerus
Health Maintenance Organization (HMO)
Limited ROM
Eligibility
9. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Pre-certification
Contracted Rates with MCOs
Occipital Bone
Peer Review Organization (PRO)
10. Are composed of three-digit codes representing a single disease or condition.
Categories
circle with a line through it)
Fee-for-Service
Qualified diagnosis
11. Make up part of the interior of the nose.
Add-on codes
circle with a line through it)
Inferior nasal conchae
Pre-determination
12. 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
Medical Records
itemized statement
Chapters
Surgical Package
13. Noninvasive - non-spreading - nonmalignant
lunula
Benign
Accept assignment
Column 1/Column 2 (previously called Comprehensive/Component) Edits
14. 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 -
-99 - Multiple Modifiers
Indemnity Insurance
Musculoskeletal System
Carcinoma (Ca) in situ
15. Poisoning cannot be determined whether intentional or accidental.
Mutually Exclusive Edits
phalanges (phalanx.s)
Undetermined
Mutually Exclusive Edits
16. 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
appendicular skeleton .
Fee-for-Service
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
HCPCS Level I codes
17. This is not specified as benign or malignant in the diagnosis or medical record.
Collagen
MEDICAID COVERAGE
Unspecified (hypertension)
Categories
18. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
Fee Schedule
Palatine bones
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Civil Monetary Penalties Law (CMPL)
19. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
stand-alone codes
The Integumentary System
Medical necessity
Short bones
20. 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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21. 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.
Category II Codes CPT
true ribs
Invalid claim
Preferred Provider plan
22. make up part of the roof of the mouth
MEDICAID COVERAGE
Palatine bones
Clean claim
encounter form
23. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
Medicaid
Coordination of Benefits (COB)
Greenstick
Fraud
24. 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's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Medicare
MEDICARE Part D
Coding
25. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
bullet (a
Neoplasm Table
Sesamoid bones
26. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Benign
Health Insurance Portability and Accountability Act (HIPAA)
Vomer
MEDICARE Part C
27. 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.
Fissure
Coinsurance
Medicare
Pre-determination
28. Is the qualifying factor or factors that must be met before a patient receives benefits.
Two triangular symbols (a
Point-of-Service plan (POS)
Eligibility
MEDICAID COVERAGE
29. 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
Chief complaint (CC)
Evaluation and Management Review
stand-alone codes
Impetigo
30. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Review of Systems (ROS)
TRICARE PLANS
Electronic Claim
premium
31. 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.
Add-on codes
False Claims Act (FCA)
Temporal Bone
Hypertension Table
32. 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
Nonparticipating physician
No ROM
-99 - Multiple Modifiers
Accident
33. 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
-32 - Mandated Services
Paper Claim
Benign
Medicare
34. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Unlisted Procedures Procedures
The St. Anthony Relative Value for Physicians (RVP)
stand-alone codes
Tabular List (Volume 1)...
35. 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.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Contracted Rates with MCOs
Mutually Exclusive Edits
Medicare Claim Status
36. 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.
ligaments
Flat bones
phalanges (phalanx.s)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
37. major skin pigment
Malignant
Dirty claim
Benign
Melanin
38. 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
Location Methods
circle with a line through it)
Provider Identification Number (PIN)
Reasons for Documentation
39. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fiscal Intermediary
Outpatient
Category III Codes CPT
encounter form
40. The moon like white area at the base of the nail.
Rib Cage
lunula
true ribs
Relative Value Payment Schedules Method
41. 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
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
HCPCS Level II codes (National Codes)
Indemnity Insurance
42. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Peer Review Organization (PRO)
There are three layers to the skin
Unlisted Procedures Procedures
-26 - Professional Component
43. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Electronic Claim
Coordination of Benefits (COB)
-32 - Mandated Services
44. the bone is crushed and or shattered.
true ribs
Comminuted fracture
Lipocyte
Gender rule
45. 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
TRICARE PLANS
HCPCS Level II codes (National Codes)
Fee Schedule
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
46. The bone is broken and pierces an internal organ
Complicated
Medicaid
Pre-determination
Sections
47. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Tabular List (Volume 1)...
Clean claim
Preferred Provider Organization (PPO)
Sebaceous glands
48. The physician must obtain this number in order to practice within a state.
Social Security Number
Reasons for Documentation
Comminuted fracture
State License Number
49. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
Temporal Bone
Hypertension Table
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
50. 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:
CPT SECTIONS.
Category II Codes CPT
The Current Procedural Terminology (CPT)
Hypertension Table