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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.
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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. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
MEDICAID COVERAGE
Exclusions and Limitations
Social Security Number
2. 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
Categorically needy -MEDICAID
Fee-for-Service
Wheal
Peer Review Organization (PRO)
3. is a traumatic injury to a joint involving the soft tissue.
Section 3 Index to External Causes of Injury (E codes)
Health Maintenance Organization (HMO)
-26 - Professional Component
sprain
4. 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:
Chapters
Hypertension Table
HCPCS Level I codes
Pre-authorization
5. death of tissue associated with loss of blood supply
Invalid claim
Nodule
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Gangrene
6. Forms the anterior part of the skull and the forehead
Benign
A plus sign (+)
Limited ROM
Frontal Bone
7. The cuticle at the lower part of the nail and this is sometimes referred to as the
Location Methods
Albino
eponychium
The Integumentary System
8. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Consultation
Established Patient
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Paper Claim
9. 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
Invalid claim
Medicare
Keratin
sprain
10. 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
Suicide Attempt
Temporal Bone
Occipital Bone
Coinsurance
11. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
Categorically needy -MEDICAID
Medigap (Medicare Supplemental Insurance)
appendicular skeleton .
Two triangular symbols (a
12. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
Preferred Provider plan
Benign
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
13. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Melanin
Limited ROM
Full ROM
False ribs
14. is defined as one who has not received any medical services within the last three years.
Sphenoid Bones
Birthday rule
Modifiers
New Patient
15. Noninvasive - non-spreading - nonmalignant
-26 - Professional Component
-99 - Multiple Modifiers
phalanges (phalanx.s)
Benign
16. requires investigation and needs further clarification.
Musculoskeletal System
triangle (a
Parietal Bones
Rejected claim
17. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Hairline
true ribs
Malignant
-32 - Mandated Services
18. Pre-determined set of benefits covered under one set annual fee.
Exclusions and Limitations
Pre-paid Health Plan
Mandible
Medical Records
19. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Long bones
true ribs
Retention of Medical Records
20. 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
HCPCS Level II codes (National Codes)
Medicare
Lacrimal bones
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
21. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Sesamoid bones
Primary malignancy
Zygoma
22. The poisoning was self-inflicted.
circle with a line through it)
Suicide Attempt
Polyp
HCPCS Level I codes
23. The bone is broken and pierces an internal organ
Deductible
Pre-determination
Complicated
Clearinghouse
24. This is a set of information the physician gathers from the patient regarding the following:
History
Polyp
Pathologic
Medically needy
25. 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
MEDICARE Part D
The St. Anthony Relative Value for Physicians (RVP)
-99 - Multiple Modifiers
Colles
26. 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.
Civil Monetary Penalties Law (CMPL)
Category II Codes CPT
encounter form
Polyp
27. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Undetermined
Musculoskeletal System
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Carpals
28. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.
Fraud
Gender rule
Non-covered benefit
The Patient Care Partnership (Patient's Bill of Rights)
29. 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
Peer Review Organization (PRO)
Carpals
Ulcermembranes
30. 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.
Performing Provider Identification Number (PPIN)
Undetermined
appendicular skeleton .
New patient
31. Benign growth extending from the surface of the mucous membrane
Polyp
The St. Anthony Relative Value for Physicians (RVP)
Pelvis
The Current Procedural Terminology (CPT)
32. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Temporal Bone
The Patient Care Partnership (Patient's Bill of Rights)
Birthday rule
Fee Schedule
33. Typically not used on the claim form unless the provider does not have an EIN.
Non-covered benefit
Social Security Number
Paper Claim
Deductible
34. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Abuse
History of present illness (HPI)
Lipocyte
ligaments
35. 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.
Inpatient
The Patient Care Partnership (Patient's Bill of Rights)
Malignant
Fee-for-Service
36. Discolored - flat lesion (freckles - tattoo marks)
MEDICARE Part C
Carpals
Macule
A plus sign (+)
37. forms the roof of the nasal cavity.
Birthday rule
Impacted
Exclusions and Limitations
Ethmoid Bone
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
Reasons for Documentation
Sub classification
Occipital Bone
Category II Codes CPT
39. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Group practice
Indemnity Insurance
Deductible
Pre-certification
40. Represent changes in the text or definition between the triangles.
Rib Cage
Physician
Two triangular symbols (a
Liability insurance
41. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Civil Monetary Penalties Law (CMPL)
Peer Review Organization (PRO)
-50 - Bilateral Procedure
Sebaceous glands
42. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
Colles
-32 - Mandated Services
The Universal Claim Form
Hypertension Table
43. 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.
Pathologic
Malignant
Primary malignancy
Sesamoid bones
44. 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
ulna
Commercial Carriers
Clearinghouse
Colles
45. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
Vesicle
The Current Procedural Terminology (CPT)
Long bones
Fissure
46. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
CPT SECTIONS.
Employer Liability
Category I Codes CPT
Personal Insurance
47. Consists of the skull - rib cage - and spine
Social Security Number
Uncertain behavior
Peer Review Organization (PRO)
axial skeleton
48. requires investigation and needs further clarification.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Humerus
Indemnity Insurance
Rejected claim
49. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Subcategories
The St. Anthony Relative Value for Physicians (RVP)
50. The moon like white area at the base of the nail.
lunula
Frontal Bone
-32 - Mandated Services
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