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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
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. 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
MEDICARE Part A
Explanation of Benefits (EOB)
Past - family and social history (PFSH)
Neoplasm Table
2. major skin pigment
Chapters
MEDICAID COVERAGE
Medical necessity
Melanin
3. Is the qualifying factor or factors that must be met before a patient receives benefits.
Workers Compensation
Uncertain behavior
Eligibility
Alphabetic Index (Volume 2)
4. 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.
Comminuted fracture
Sesamoid bones
Temporal Bone
-90 - Reference (Outside) Laboratory
5. Benign growth extending from the surface of the mucous membrane
Comminuted fracture
Ethmoid Bone
Polyp
-50 - Bilateral Procedure
6. solid - round or oval elevated lesion more than 1 cm in diameter
MEDICARE Part D
Carcinoma (Ca) in situ
Compliance Regulations
Nodule
7. The cuticle at the lower part of the nail and this is sometimes referred to as the
A plus sign (+)
False Claims Act (FCA)
eponychium
Temporal Bone
8. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
MEDICARE Part D
Occipital Bone
Pre-authorization
Impetigo
9. numbers 8-10 - are attached to the sternum by cartilage
False ribs
Unique Provider Identification Number (UPIN)
Contracted Rates with MCOs
Coordination of Benefits (COB)
10. 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.
itemized statement
Point-of-Service plan (POS)
Keratin
Lacrimal bones
11. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
phalanges (phalanx.s)
Vomer
MEDICARE Part B
Medigap (Medicare Supplemental Insurance)
12. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Deductible
Outpatient
sebaceous(oil) glands and the suddoriferous (sweat) glands
Two triangular symbols (a
13. The cuticle at the lower part of the nail and this is sometimes referred to as the
Coding
sprain
eponychium
The St. Anthony Relative Value for Physicians (RVP)
14. 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:
Hypertension Table
Unspecified nature
False Claims Act (FCA)
Gangrene
15. The physician must obtain this number in order to practice within a state.
Unlisted Procedures Procedures
Personal Insurance
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
State License Number
16. uncertain whether benign or malignant; borderline malignancy
Electronic Claim
Remittance Advice
Uncertain behavior
False Claims Act (FCA)
17. The fractured area of bone collapses on itself.
Compression fracture
Unauthorized benefit
Deductible
Medicare Claim Status
18. - 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
ulna
Medigap (Medicare Supplemental Insurance)
History of present illness (HPI)
Accident
19. Consists of the skull - rib cage - and spine
Physician
axial skeleton
Point-of-Service plan (POS)
Impetigo
20. 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).
lunula
Sections
No ROM
Paper Claim
21. 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.
Capitated Rates
Accident
Pre-authorization
Group practice
22. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
-26 - Professional Component
Dirty claim
Pre-certification
Salter-Harris
23. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Mutually Exclusive Edits
Parietal Bones
Column 1/Column 2 (previously called Comprehensive/Component) Edits
HCPCS Level II codes (National Codes)
24. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Carpals
Section 3 Index to External Causes of Injury (E codes)
The St. Anthony Relative Value for Physicians (RVP)
Indemnity Insurance
25. Produce secretions that allow the body to be moisturized or cooled.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
sebaceous(oil) glands and the suddoriferous (sweat) glands
HCPCS Level II codes (National Codes)
Reasons for Documentation
26. 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
Mutually Exclusive Edits
Past - family and social history (PFSH)
Capitated Rates
27. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Pre-certification
Peer Review Organization (PRO)
Explanation of Benefits (EOB)
28. death of tissue associated with loss of blood supply
Workers Compensation
-32 - Mandated Services
Unspecified nature
Gangrene
29. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
co-payment
-99 - Multiple Modifiers
Consultation
Categories
30. Most billing-related cases are based on HIPAA and False Claims Act.
Eligibility
Compliance Regulations
Hairline
False ribs
31. make up part of the roof of the mouth
Palatine bones
Clean claim
Ischium
triangle (a
32. 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
itemized statement
appendicular skeleton .
Impetigo
MEDICARE Part B
33. 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
Workers Compensation
Ulcermembranes
Modifiers
Physician
34. This is not specified as benign or malignant in the diagnosis or medical record.
Employee Liability
Unspecified (hypertension)
Group Provider Number
co-payment
35. 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
stand-alone codes
Clearinghouse
Preferred Provider Organization (PPO)
Greenstick
36. 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
Occipital Bone
ulna
Health Maintenance Organization (HMO)
Personal Insurance
37. 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.
Medicare Claim Status
The Current Procedural Terminology (CPT)
Mutually Exclusive Edits
Dirty claim
38. 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
Peer Review Organization (PRO)
Dirty claim
Coinsurance
Coding
39. Is the upper arm bone.
Fraud
Humerus
MEDICARE Part D
There are two types of sweat glands
40. Any fracture occurring spontaneously as a result of disease.
premium
Pathologic
Eligibility
Polyp
41. is defined as one who has not received any medical services within the last three years.
False Claims Act (FCA)
New Patient
Coinsurance
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
42. Are conditions - situations - and services not covered by the insurance carrier.
Chapters
Comminuted fracture
Exclusions and Limitations
Medical Records
43. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Blue Cross/Blue Shield Plans
New patient
Preferred Provider plan
44. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Medically needy
The Universal Claim Form
MEDICARE Part A
Add-on codes
45. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
Melanin
Group practice
MEDICAID COVERAGE
46. 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
co-payment
Gender rule
Benign (hypertension)
47. 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
Personal Insurance
TRICARE PLANS
Provider Identification Number (PIN)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
48. 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
Pre-authorization
History of present illness (HPI)
lunula
49. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Undetermined
Qualified diagnosis
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Indemnity Insurance
50. Law passed by the federal government to prosecute cases of Medicaid fraud.
Benign (hypertension)
Paper Claim
Civil Monetary Penalties Law (CMPL)
Inpatient