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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. 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
Vesicle
The Good Samaritan Act
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
2. 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.
bullet (a
Deductible
Pre-determination
-50 - Bilateral Procedure
3. 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
Unique Provider Identification Number (UPIN)
Liability insurance
true ribs
encounter form
4. 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
Health Maintenance Organization (HMO)
Gangrene
Benign (hypertension)
phalanges (phalanx.s)
5. Structural protein found in the skin and connective tissue
Collagen
Category III Codes CPT
Review of Systems (ROS)
Subcategories
6. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
-26 - Professional Component
Pre-certification
Categorically needy -MEDICAID
Maxilla
7. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Outpatient
Employer Liability
False Claims Act (FCA)
Past - family and social history (PFSH)
8. 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
Suicide Attempt
TRICARE
Fee-for-Service
Vesicle
9. 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
Birthday rule
MEDICAID COVERAGE
MEDICARE Part D
Past - family and social history (PFSH)
10. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.
Lipocyte
Group Provider Number
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Categories
11. 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.
Employee Liability
Group practice
Maxilla
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
12. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Secondary malignancy
Section 3 Index to External Causes of Injury (E codes)
encounter form
Secondary malignancy
13. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Pre-certification
Modifiers
Established Patient
Nonparticipating physician
14. open sore on the skin or mucous
bullet (a
Ulcermembranes
Temporal Bone
Exclusions and Limitations
15. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Suicide Attempt
The Current Procedural Terminology (CPT)
Keratin
Tabular List (Volume 1)...
16. Poisoning cannot be determined whether intentional or accidental.
Pre-certification
Undetermined
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Fiscal Intermediary
17. 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
Compliance Regulations
Reasons for Documentation
Qualified diagnosis
stand-alone codes
18. Are composed of three-digit codes representing a single disease or condition.
Parietal Bones
Health practitioner
History
Categories
19. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Employer Identification Number (EIN)
Chapters
Colles
Ulcermembranes
20. 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.
Unlisted Procedures Procedures
Salter-Harris
Retention of Medical Records
phalanges (phalanx.s)
21. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu
Blue Cross/Blue Shield Plans
Parietal Bones
premium
Salter-Harris
22. '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
TRICARE PLANS
Employee Liability
Occipital Bone
23. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
Complicated
Vesicle
Sub classification
Health practitioner
24. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
False Claims Act (FCA)
Employer Liability
A plus sign (+)
Outpatient
25. is defined as one who has not received any medical services within the last three years.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Vomer
Medigap (Medicare Supplemental Insurance)
New Patient
26. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Flat bones
Chief complaint
Clearinghouse
Invalid claim
27. 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
Employee Liability
The Current Procedural Terminology (CPT)
Clearinghouse
Secondary malignancy
28. 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
Gangrene
stand-alone codes
Unspecified (hypertension)
Occipital Bone
29. The physician must obtain this number in order to practice within a state.
State License Number
itemized statement
Complicated
Palatine bones
30. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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31. 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
CPT SECTIONS.
Category I Codes CPT
phalanges (phalanx.s)
ligaments
32. Deficient in pigment (melanin)
False ribs
Keratin
-90 - Reference (Outside) Laboratory
Albino
33. 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
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
MEDICARE Part C
Vomer
Deductible
34. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
The Universal Claim Form
Abuse
-26 - Professional Component
Mutually Exclusive Edits
35. The reason the patient came to see the physician.
Radius
Employee Liability
Chief complaint (CC)
Sphenoid Bones
36. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Consultation
Collagen
37. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
bullet (a
Chapters
Complicated
Medically needy
38. 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
Group practice
Commercial Carriers
Unspecified (hypertension)
TRICARE PLANS
39. paired bones at the corner of each eye that cradle the tear ducts.
Carpals
Lacrimal bones
bullet (a
Medicare
40. Law passed by the federal government to prosecute cases of Medicaid fraud.
Nonparticipating physician
Civil Monetary Penalties Law (CMPL)
Pathologic
Uncertain behavior
41. 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
ulna
Non-covered benefit
Accident
Unlisted Procedures Procedures
42. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Past - family and social history (PFSH)
Personal Insurance
Multigravida
Indemnity Insurance
43. 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
Keratin
Dirty claim
Surgical Package
44. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Colles
Group practice
co-payment
Column 1/Column 2 (previously called Comprehensive/Component) Edits
45. Is an electronic or paper-based report of payment sent by the payer to the provider.
Musculoskeletal System
Remittance Advice
Evaluation and Management Review
False ribs
46. 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
Compliance Regulations
Impetigo
Assault
Fee Schedule
47. 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 -
Hairline
False Claims Act (FCA)
Parietal Bones
essential modifiers
48. 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
Blue Cross/Blue Shield Plans
Physician
Employer Liability
Pre-determination
49. 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.
-99 - Multiple Modifiers
-32 - Mandated Services
Frontal Bone
Occipital Bone
50. Represents a new procedure or service code added since the previous edition of the manual.
Indemnity Insurance
Established Patient
The Current Procedural Terminology (CPT)
bullet (a