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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
Participating physician
Greenstick
Clean claim
Fee-for-Service
2. Produce secretions that allow the body to be moisturized or cooled.
Pre-determination
Reasons for Documentation
Medical necessity
sebaceous(oil) glands and the suddoriferous (sweat) glands
3. 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
History of present illness (HPI)
Exclusions and Limitations
Explanation of Benefits (EOB)
Coinsurance
4. Small collection of clear fluid;blister
A plus sign (+)
MEDICARE Part A
Qualified diagnosis
Vesicle
5. 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.
False Claims Act (FCA)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Sesamoid bones
Flat bones
6. 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
Fissure
HCPCS Level II codes (National Codes)
Spinal/Vertebral Column
Collagen
7. Consists of the skull - rib cage - and spine
axial skeleton
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
CPT SECTIONS.
Categories
8. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Pubic bone
Keratin
Fee-for-Service
Liability insurance
9. Upper jaw bone
Medicare Claim Status
Rib Cage
Benign
Maxilla
10. 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.
History of present illness (HPI)
MEDICARE Part B
Performing Provider Identification Number (PPIN)
Vesicle
11. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Commercial Carriers
There are two types of sweat glands
Employer Identification Number (EIN)
Long bones
12. 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).
Sections
Electronic Claim
Pelvis
Categorically needy -MEDICAID
13. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
lunula
Point-of-Service plan (POS)
Health Insurance Portability and Accountability Act (HIPAA)
Gender rule
14. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Greenstick
Polyp
Categorically needy -MEDICAID
15. 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
Full ROM
Peer Review Organization (PRO)
Group Insurance
Paper Claim
16. 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....
Unauthorized benefit
Established patient
Carcinoma (Ca) in situ
Contracted Rates with MCOs
17. 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
Provider Identification Number (PIN)
ligaments
Pre-authorization
Chief complaint
18. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
-51 - Multiple Procedures
Column 1/Column 2 (previously called Comprehensive/Component) Edits
The Integumentary System
19. The main term in the index may by followed by terms within parenthesis.
Alphabetic Index (Volume 2)
Dirty claim
Palatine bones
Sub classification
20. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Employer Identification Number (EIN)
Vomer
Radius
Surgical Package
21. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
Clean claim
sprain
Preferred Provider plan
Health Maintenance Organization (HMO)
22. This is a set of information the physician gathers from the patient regarding the following:
Advance Beneficiary Notice
Fee-for-Service
History
Workers Compensation
23. Represents a new procedure or service code added since the previous edition of the manual.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Pre-authorization
bullet (a
Health practitioner
24. forms the roof of the nasal cavity.
Location Methods
Ethmoid Bone
Alopecia
Health Care Financing Administration Common Procedure Coding System
25. forms the roof of the nasal cavity.
Pathologic
Fiscal Intermediary
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Ethmoid Bone
26. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
Gender rule
Group Insurance
Compression fracture
circle with a line through it)
27. A fracture of the epiphyseal plate in children.
Neoplasm Table
Alopecia
Salter-Harris
Pelvis
28. Upper jaw bone
No ROM
The Good Samaritan Act
Maxilla
Compliance Regulations
29. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Compliance Regulations
Unauthorized benefit
-51 - Multiple Procedures
Gender rule
30. Law passed by the federal government to prosecute cases of Medicaid fraud.
axial skeleton
Multigravida
Civil Monetary Penalties Law (CMPL)
Medicaid
31. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
phalanges (phalanx.s)
Carcinoma (Ca) in situ
Social Security Number
History of present illness (HPI)
32. '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
Carpals
Employee Liability
stand-alone codes
Reasons for Documentation
33. poisoning was inflicted by another person with intent to kill or injure
The Patient Care Partnership (Patient's Bill of Rights)
Participating physician
Workers Compensation
Assault
34. 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.
Colles
HCPCS Level I codes
Remittance Advice
Add-on codes
35. numbers 8-10 - are attached to the sternum by cartilage
Group practice
Coordination of Benefits (COB)
False ribs
Nodule
36. Is the upper arm bone.
Pelvis
Evaluation and Management Review
Humerus
Evaluation and Management Review
37. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Qualified diagnosis
Personal Insurance
Undetermined
38. 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.
phalanges (phalanx.s)
Undetermined
Invalid claim
Blue Cross/Blue Shield Plans
39. 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.
Albino
Mutually Exclusive Edits
Category II Codes CPT
Surgical Package
40. 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
-32 - Mandated Services
Accident
Personal Insurance
Fee-for-Service
41. 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
ligaments
TRICARE PLANS
Liability insurance
Fee Schedule
42. most synarthroses are immovable joints held together by fibrous tissue.
Section 3 Index to External Causes of Injury (E codes)
sprain
No ROM
The Integumentary System
43. 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
Parietal Bones
Liability insurance
Neoplasm Table
Subcategories
44. A fracture of the epiphyseal plate in children.
Fissure
Salter-Harris
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Ulcermembranes
45. Deficient in pigment (melanin)
Electronic Claim
History of present illness (HPI)
Albino
Fiscal Intermediary
46. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
Commercial Carriers
Pre-paid Health Plan
Workers Compensation
TRICARE PLANS
47. The poisoning was self-inflicted.
Category I Codes CPT
Unspecified nature
Suicide Attempt
phalanges (phalanx.s)
48. 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
Carcinoma (Ca) in situ
Medicare Claim Status
Location Methods
lunula
49. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Group practice
There are two types of sweat glands
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Abuse
50. 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 -
essential modifiers
Tabular List (Volume 1)...
Albino
Keratin