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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. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Lipocyte
Category III Codes CPT
Uncertain behavior
2. 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)
Carcinoma (Ca) in situ
Neoplasm Table
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
3. 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
Established patient
Benign (hypertension)
Albino
4. 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
Capitated Rates
Patient Confidentiality
HCPCS Level II codes (National Codes)
Deductible
5. The fractured area of bone collapses on itself.
Compression fracture
Subcategories
Category III Codes CPT
Employee Liability
6. 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
Assault
Alopecia
Fee Schedule
Gangrene
7. 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.
Outpatient
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Evaluation and Management Review
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
8. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)
There are three layers to the skin
co-payment
Chapters
Carpals
9. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Lipocyte
Chapters
The Good Samaritan Act
10. Is the lower medial arm bone.
State License Number
ulna
Compliance Regulations
Health Care Financing Administration Common Procedure Coding System
11. Poisoning cannot be determined whether intentional or accidental.
Preferred Provider plan
Surgical Package
Albino
Undetermined
12. Is the qualifying factor or factors that must be met before a patient receives benefits.
Keratin
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
HCPCS Level I codes
Eligibility
13. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
CPT SECTIONS.
National Correct Coding Initiative (NCCI)
Employer Liability
Compliance Regulations
14. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
MEDICARE Part A
Medical Records
Add-on codes
Clearinghouse
15. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Primary malignancy
Ischium
Pre-determination
16. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Reasons for Documentation
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Tabular List (Volume 1)...
Primary malignancy
17. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Albino
Health Insurance Portability and Accountability Act (HIPAA)
Neoplasm Table
Contracted Rates with MCOs
18. Make up part of the interior of the nose.
triangle (a
Polyp
Inferior nasal conchae
Primary malignancy
19. 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.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Primary malignancy
Advance Beneficiary Notice
Colles
20. 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
History of present illness (HPI)
stand-alone codes
Long bones
Add-on codes
21. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Fee-for-Service
Modifiers
Contracted Rates with MCOs
22. Are composed of three-digit codes representing a single disease or condition.
Categories
State License Number
Fee Schedule
Participating physician
23. 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
Assault
MEDICAID COVERAGE
MEDICARE Part D
Neoplasm Table
24. 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
stand-alone codes
Radius
Gangrene
TRICARE
25. 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
Group Insurance
Multigravida
Undetermined
Pre-certification
26. Deficient in pigment (melanin)
Albino
Sub classification
-99 - Multiple Modifiers
lunula
27. - 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.
Greenstick
Pubic bone
Unauthorized benefit
Unlisted Procedures Procedures
28. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
Vomer
Paper Claim
Patient Confidentiality
Exclusions and Limitations
29. Is the upper arm bone.
Spinal/Vertebral Column
Humerus
Performing Provider Identification Number (PPIN)
-32 - Mandated Services
30. Forms the sides of the cranium
sebaceous(oil) glands and the suddoriferous (sweat) glands
Parietal Bones
Chief complaint
Gender rule
31. 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
Column 1/Column 2 (previously called Comprehensive/Component) Edits
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Spinal/Vertebral Column
Rib Cage
32. 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.
Remittance Advice
Preferred Provider plan
Fee-for-Service
encounter form
33. 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
stand-alone codes
Pubic bone
Point-of-Service plan (POS)
Fee Schedule
34. solid - round or oval elevated lesion more than 1 cm in diameter
Parietal Bones
Categorically needy -MEDICAID
Nodule
co-payment
35. Is the lower medial arm bone.
Relative Value Payment Schedules Method
ulna
Health practitioner
Primary malignancy
36. Noninvasive - non-spreading - nonmalignant
Gender rule
Benign
Pelvis
Column 1/Column 2 (previously called Comprehensive/Component) Edits
37. 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:
Indemnity Insurance
Hypertension Table
Alphabetic Index (Volume 2)
MEDICAID COVERAGE
38. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options
Reasons for Documentation
Preferred Provider Organization (PPO)
Group Provider Number
CPT SECTIONS.
39. forms the two lower sides of the cranium.
Personal Insurance
Preferred Provider Organization (PPO)
Temporal Bone
Musculoskeletal System
40. Groove or crack like sore
Fissure
Blue Cross/Blue Shield Plans
Workers Compensation
Rib Cage
41. 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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42. 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
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
MEDICARE Part C
eponychium
History
43. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
Full ROM
Lacrimal bones
Primary malignancy
44. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Long bones
Vomer
Impetigo
Hypertension Table
45. The bone is broken and pierces an internal organ
False Claims Act (FCA)
Patient Confidentiality
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Complicated
46. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Lacrimal bones
Malignant
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Greenstick
47. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran
Clearinghouse
New patient
Column 1/Column 2 (previously called Comprehensive/Component) Edits
There are two types of sweat glands
48. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
A plus sign (+)
The Current Procedural Terminology (CPT)
Group practice
49. 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.
Health Insurance Portability and Accountability Act (HIPAA)
Accept assignment
New patient
Consultation
50. The physician must obtain this number in order to practice within a state.
Medically needy
Musculoskeletal System
MEDICARE Part D
State License Number