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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. death of tissue associated with loss of blood supply
Frontal Bone
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Blue Cross/Blue Shield Plans
Gangrene
2. 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
Workers Compensation
Employee Liability
Invalid claim
Clearinghouse
3. This is not specified as benign or malignant in the diagnosis or medical record.
Reasons for Documentation
Hairline
Unspecified (hypertension)
Impacted
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
Electronic Claim
Relative Value Payment Schedules Method
Rejected claim
Medigap (Medicare Supplemental Insurance)
5. Benign growth extending from the surface of the mucous membrane
Surgical Package
Eligibility
Polyp
Paper Claim
6. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Tabular List (Volume 1)...
Polyp
Category III Codes CPT
Malignant
7. 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
Vesicle
A plus sign (+)
Patient Confidentiality
nonessential modifiers
8. Deficient in pigment (melanin)
False Claims Act (FCA)
Explanation of Benefits (EOB)
Albino
bullet (a
9. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Spinal/Vertebral Column
Past - family and social history (PFSH)
Category II Codes CPT
-32 - Mandated Services
10. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Surgical Package
upper appendicular skeleton
Reasons for Documentation
There are two types of sweat glands
11. Describes the services billed and includes a breakdown of how the payment is determined
Advance Beneficiary Notice
Pubic bone
Explanation of Benefits (EOB)
Contracted Rates with MCOs
12.
Undetermined
nonessential modifiers
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
appendicular skeleton .
13. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
Short bones
Health practitioner
Blue Cross/Blue Shield Plans
14. Poisoning cannot be determined whether intentional or accidental.
Health Care Financing Administration Common Procedure Coding System
Medical Records
Undetermined
Pathologic
15. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features
Provider Identification Number (PIN)
Pre-authorization
Accident
Electronic Claim
16. 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
TRICARE
stand-alone codes
Ethmoid Bone
Established Patient
17. 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.
Impacted
Mutually Exclusive Edits
No ROM
-32 - Mandated Services
18. 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
sebaceous(oil) glands and the suddoriferous (sweat) glands
Birthday rule
MEDICARE Part D
Column 1/Column 2 (previously called Comprehensive/Component) Edits
19. Small collection of clear fluid;blister
eponychium
Eligibility
Vesicle
-51 - Multiple Procedures
20. 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.
ligaments
Carcinoma (Ca) in situ
Melanin
Preferred Provider plan
21. 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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22. Is a working diagnosis which is not yet established.
Pelvis
Evaluation and Management Review
Unspecified nature
Qualified diagnosis
23. Produce secretions that allow the body to be moisturized or cooled.
Lipocyte
sebaceous(oil) glands and the suddoriferous (sweat) glands
Spinal/Vertebral Column
Alopecia
24. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Pre-certification
Relative Value Payment Schedules Method
History of present illness (HPI)
Eligibility
25. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Ethmoid Bone
Provider Identification Number (PIN)
sebaceous(oil) glands and the suddoriferous (sweat) glands
Flat bones
26. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.
Flat bones
encounter form
Physician
Non-covered benefit
27. poisoning was inflicted by another person with intent to kill or injure
Assault
Medigap (Medicare Supplemental Insurance)
Commercial Carriers
Remittance Advice
28. 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.
Medical necessity
Pre-authorization
Sesamoid bones
A plus sign (+)
29. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Impacted
Chapters
encounter form
Lacrimal bones
30. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Occipital Bone
Evaluation and Management Review
Category III Codes CPT
31. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Abuse
Flat bones
Impetigo
32. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Performing Provider Identification Number (PPIN)
Ethmoid Bone
Alphabetic Index (Volume 2)
Categorically needy -MEDICAID
33. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Benign
Impetigo
CPT SECTIONS.
Add-on codes
34. Is a working diagnosis which is not yet established.
Qualified diagnosis
Medicare
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
New Patient
35. 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
National Correct Coding Initiative (NCCI)
ligaments
Deductible
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
36. 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
-99 - Multiple Modifiers
Blue Cross/Blue Shield Plans
Medically needy
Consultation
37. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Tabular List (Volume 1)...
MEDICARE Part A
The Universal Claim Form
38. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Capitated Rates
encounter form
Compliance Regulations
Employer Identification Number (EIN)
39. 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).
Indemnity Insurance
-51 - Multiple Procedures
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Sections
40. 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.
co-payment
Accept assignment
Sections
Preferred Provider plan
41. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
The Integumentary System
Accept assignment
Subcategories
Health Maintenance Organization (HMO)
42. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Peer Review Organization (PRO)
Clearinghouse
Secondary malignancy
Health Care Financing Administration Common Procedure Coding System
43. Mild or controlled hypertension and no damage to the vascular system or organs.
Accident
Benign (hypertension)
Pubic bone
The Integumentary System
44. Groove or crack like sore
Review of Systems (ROS)
-51 - Multiple Procedures
Coinsurance
Fissure
45. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Unspecified nature
Performing Provider Identification Number (PPIN)
Consultation
New patient
46. Is the qualifying factor or factors that must be met before a patient receives benefits.
Provider Identification Number (PIN)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Eligibility
Physician
47. 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.
Malignant
Chief complaint (CC)
Primary malignancy
False Claims Act (FCA)
48. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
Collagen
Malignant
HCPCS Level II codes (National Codes)
Established Patient
49. 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
Modifiers
Ethmoid Bone
Pre-paid Health Plan
Preferred Provider Organization (PPO)
50. Mild or controlled hypertension and no damage to the vascular system or organs.
Unspecified nature
Categorically needy -MEDICAID
Frontal Bone
Benign (hypertension)