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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. 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
TRICARE
Pelvis
Past - family and social history (PFSH)
Full ROM
2. 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.
ligaments
Ulcermembranes
Fraud
itemized statement
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
Invalid claim
Coinsurance
Sebaceous glands
Explanation of Benefits (EOB)
4. 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
Relative Value Payment Schedules Method
Flat bones
Invalid claim
Location Methods
5. .. lower jaw bone.
Mandible
MEDICARE Part B
Performing Provider Identification Number (PPIN)
Compliance Regulations
6. Is the lateral lower arm bone (in line with the thumb).
No ROM
Location Methods
The Universal Claim Form
Radius
7. 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
Medigap (Medicare Supplemental Insurance)
Hypertension Table
Compliance Regulations
Paper Claim
8. Is one who has no contract with the health insurance plan.
Inferior nasal conchae
Nonparticipating physician
Melanin
Sebaceous glands
9. The main term in the index may by followed by terms within parenthesis.
ulna
Alphabetic Index (Volume 2)
Musculoskeletal System
Malignant
10. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Spinal/Vertebral Column
Hairline
Deductible
Health Insurance Portability and Accountability Act (HIPAA)
11. The fractured area of bone collapses on itself.
phalanges (phalanx.s)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Consultation
Compression fracture
12. 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.'
Dirty claim
Medical necessity
Pubic bone
Nodule
13. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
Contracted Rates with MCOs
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
State License Number
encounter form
14. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
Sesamoid bones
Non-covered benefit
Chief complaint (CC)
upper appendicular skeleton
15. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Pre-certification
MEDICARE Part A
Workers Compensation
-26 - Professional Component
16. most synarthroses are immovable joints held together by fibrous tissue.
Health Care Financing Administration Common Procedure Coding System
Disability insurance
No ROM
Zygoma
17. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
Civil Monetary Penalties Law (CMPL)
Birthday rule
nonessential modifiers
Frontal Bone
18. forms the two lower sides of the cranium.
Temporal Bone
Gangrene
Neoplasm Table
Nonparticipating physician
19. Is the lateral lower arm bone (in line with the thumb).
Group Insurance
Fee Schedule
Radius
Sub classification
20. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
A plus sign (+)
Coinsurance
Wheal
Hairline
21. Represent changes in the text or definition between the triangles.
Comminuted fracture
Categorically needy -MEDICAID
ulna
Two triangular symbols (a
22. 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
Reasons for Documentation
MEDICAID COVERAGE
Occipital Bone
Remittance Advice
23. 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
Coordination of Benefits (COB)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
triangle (a
24. Mild or controlled hypertension and no damage to the vascular system or organs.
Indemnity Insurance
Benign (hypertension)
Hairline
Surgical Package
25. 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.
Remittance Advice
Performing Provider Identification Number (PPIN)
Coordination of Benefits (COB)
Category III Codes CPT
26. 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.
axial skeleton
No ROM
Preferred Provider plan
There are two types of sweat glands
27. Poisoning cannot be determined whether intentional or accidental.
Patient Confidentiality
Undetermined
Alphabetic Index (Volume 2)
Inpatient
28. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Health Maintenance Organization (HMO)
Workers Compensation
Macule
History of present illness (HPI)
29. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Hairline
HCPCS Level II codes (National Codes)
HCPCS Level I codes
Temporal Bone
30. 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
Long bones
Polyp
Commercial Carriers
Pre-determination
31. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Fiscal Intermediary
Contracted Rates with MCOs
Subcategories
Add-on codes
32. paired bones at the corner of each eye that cradle the tear ducts.
Keratin
Zygoma
Chief complaint (CC)
Lacrimal bones
33. Typically not used on the claim form unless the provider does not have an EIN.
Past - family and social history (PFSH)
sprain
Vomer
Social Security Number
34. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.
Unlisted Procedures Procedures
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Inpatient
Zygoma
35. Any fracture occurring spontaneously as a result of disease.
Lipocyte
Alphabetic Index (Volume 2)
Clearinghouse
Pathologic
36. Numbers 1-7 - attach directly to the sternum in the front of the body.
Salter-Harris
true ribs
TRICARE
Fraud
37. 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
Category III Codes CPT
Gangrene
Chapters
Disability insurance
38. 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
Patient Confidentiality
Melanin
Accident
Preferred Provider Organization (PPO)
39. 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
Chief complaint
The Integumentary System
-51 - Multiple Procedures
Compliance Regulations
40. 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
Participating physician
Reasons for Documentation
Dirty claim
Group Provider Number
41. 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
Liability insurance
Pathologic
Compliance Regulations
Wheal
42. 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
Capitated Rates
Reasons for Documentation
Hairline
Fraud
43. Most billing-related cases are based on HIPAA and False Claims Act.
Zygoma
Category III Codes CPT
Compliance Regulations
Contracted Rates with MCOs
44. is a traumatic injury to a joint involving the soft tissue.
sprain
Participating physician
False Claims Act (FCA)
MEDICAID COVERAGE
45. Numbers 1-7 - attach directly to the sternum in the front of the body.
Coordination of Benefits (COB)
true ribs
HCPCS Level II codes (National Codes)
Provider Identification Number (PIN)
46. Forms the sides of the cranium
Collagen
Group Provider Number
Preferred Provider plan
Parietal Bones
47. 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.
Macule
False Claims Act (FCA)
MEDICAID COVERAGE
Medicare Claim Status
48. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Capitated Rates
Workers Compensation
Medigap (Medicare Supplemental Insurance)
Blue Cross/Blue Shield Plans
49. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
axial skeleton
Occipital Bone
History of present illness (HPI)
Accept assignment
50. make up part of the roof of the mouth
Fee Schedule
Palatine bones
Civil Monetary Penalties Law (CMPL)
MEDICARE Part A