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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. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Unlisted Procedures Procedures
encounter form
Hairline
Colles
2. 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.
New patient
Two triangular symbols (a
State License Number
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
3. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Deductible
Personal Insurance
Lipocyte
4. 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
HCPCS Level II codes (National Codes)
MEDICARE Part B
Polyp
TRICARE
5. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Secondary malignancy
The Current Procedural Terminology (CPT)
Full ROM
Medigap (Medicare Supplemental Insurance)
6. 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)
co-payment
Categorically needy -MEDICAID
Humerus
Frontal Bone
7. 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
Review of Systems (ROS)
Chief complaint (CC)
Unspecified nature
8. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Past - family and social history (PFSH)
Carcinoma (Ca) in situ
Uncertain behavior
Health practitioner
9. A fracture of the epiphyseal plate in children.
Gangrene
Preferred Provider plan
Salter-Harris
Category I Codes CPT
10. The main term in the index may by followed by terms within parenthesis.
Alphabetic Index (Volume 2)
Clean claim
Humerus
Sphenoid Bones
11. 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
Malignant
CPT SECTIONS.
Assault
ligaments
12. Contains complete - necessary information - but is incorrect or illogical in some way.
Exclusions and Limitations
Invalid claim
Pathologic
triangle (a
13. 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
Albino
Uncertain behavior
Unique Provider Identification Number (UPIN)
Coinsurance
14. 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
Disability insurance
History
Greenstick
TRICARE PLANS
15. 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
Complicated
Medicaid
The Universal Claim Form
Palatine bones
16. 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
The Integumentary System
Outpatient
Malignant
Group Insurance
17. Describes the services billed and includes a breakdown of how the payment is determined
Explanation of Benefits (EOB)
true ribs
Dirty claim
Impetigo
18. Represents a new procedure or service code added since the previous edition of the manual.
Group practice
bullet (a
The Integumentary System
Patient Confidentiality
19. Small collection of clear fluid;blister
Dirty claim
Vesicle
Tabular List (Volume 1)...
-90 - Reference (Outside) Laboratory
20. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu
Neoplasm Table
lunula
Greenstick
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
21. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
Fissure
Subcategories
The Integumentary System
Full ROM
22. 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.
Carcinoma (Ca) in situ
Lipocyte
Retention of Medical Records
Rejected claim
23. 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
Provider Identification Number (PIN)
Accident
Carcinoma (Ca) in situ
co-payment
24. 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
The Good Samaritan Act
Relative Value Payment Schedules Method
HCPCS Level II codes (National Codes)
Medically needy
25. 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
Inpatient
Unauthorized benefit
TRICARE PLANS
Pre-paid Health Plan
26. This is a set of information the physician gathers from the patient regarding the following:
The Current Procedural Terminology (CPT)
co-payment
History
Consultation
27. Is the lateral lower arm bone (in line with the thumb).
Fee Schedule
Physician
Radius
Lipocyte
28. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
MEDICARE Part B
Comminuted fracture
triangle (a
Unspecified nature
29. .. lower jaw bone.
Pre-authorization
Mandible
Sub classification
Group practice
30. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
-99 - Multiple Modifiers
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Medical Records
31. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Medically needy
Full ROM
Fraud
Electronic Claim
32. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
premium
National Correct Coding Initiative (NCCI)
Zygoma
-90 - Reference (Outside) Laboratory
33. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
Group Provider Number
Evaluation and Management Review
Ulcermembranes
bullet (a
34. 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.
Invalid claim
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Fee Schedule
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
35. This is not specified as benign or malignant in the diagnosis or medical record.
upper appendicular skeleton
Non-covered benefit
Unspecified (hypertension)
-90 - Reference (Outside) Laboratory
36. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Rib Cage
Ischium
Gender rule
Personal Insurance
37. 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
Provider Identification Number (PIN)
Reasons for Documentation
Subcategories
Uncertain behavior
38. A fat cell
Medicare Claim Status
Lipocyte
Subcategories
Preferred Provider plan
39. 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
Performing Provider Identification Number (PPIN)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Clearinghouse
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
40. most synarthroses are immovable joints held together by fibrous tissue.
Sections
No ROM
-90 - Reference (Outside) Laboratory
Radius
41. 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
Fiscal Intermediary
Temporal Bone
HCPCS Level II codes (National Codes)
History of present illness (HPI)
42. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
Personal Insurance
Macule
Disability insurance
There are three layers to the skin
43. Law passed by the federal government to prosecute cases of Medicaid fraud.
Coordination of Benefits (COB)
Greenstick
National Correct Coding Initiative (NCCI)
Civil Monetary Penalties Law (CMPL)
44. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Point-of-Service plan (POS)
Wheal
State License Number
Evaluation and Management Review
45. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
MEDICARE Part D
Coding
TRICARE
Greenstick
46. 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.
Ethmoid Bone
New patient
Invalid claim
Limited ROM
47. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Musculoskeletal System
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Unique Provider Identification Number (UPIN)
Unspecified nature
48. 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
Rejected claim
HCPCS Level II codes (National Codes)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Indemnity Insurance
49. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Undetermined
Vesicle
Inferior nasal conchae
Long bones
50. Pre-determined set of benefits covered under one set annual fee.
Occipital Bone
Pelvis
Medicare
Pre-paid Health Plan