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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. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Civil Monetary Penalties Law (CMPL)
Medicaid
appendicular skeleton .
Flat bones
2. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Inferior nasal conchae
Performing Provider Identification Number (PPIN)
Medically needy
Melanin
3. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
Nodule
Reasons for Documentation
Birthday rule
Point-of-Service plan (POS)
4. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Tabular List (Volume 1)...
Nonparticipating physician
Medicare
MEDICARE Part A
5. Mild or controlled hypertension and no damage to the vascular system or organs.
premium
Salter-Harris
Benign (hypertension)
MEDICAID COVERAGE
6. Is the qualifying factor or factors that must be met before a patient receives benefits.
Vesicle
Eligibility
Two triangular symbols (a
appendicular skeleton .
7. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
The St. Anthony Relative Value for Physicians (RVP)
MEDICARE Part A
axial skeleton
Health Insurance Portability and Accountability Act (HIPAA)
8. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Reasons for Documentation
stand-alone codes
Group Insurance
Carcinoma (Ca) in situ
9. Is the lateral lower arm bone (in line with the thumb).
Medicare Claim Status
Disability insurance
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Radius
10. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fiscal Intermediary
TRICARE PLANS
Complicated
-32 - Mandated Services
11. Is a working diagnosis which is not yet established.
bullet (a
Pelvis
Inpatient
Qualified diagnosis
12. This is a set of information the physician gathers from the patient regarding the following:
Pre-authorization
Deductible
Inpatient
History
13. 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.
Birthday rule
nonessential modifiers
Personal Insurance
Hypertension Table
14. 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
Radius
Unspecified (hypertension)
Categories
Preferred Provider Organization (PPO)
15. Is a working diagnosis which is not yet established.
Long bones
MEDICARE Part B
Qualified diagnosis
Sesamoid bones
16. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.
-51 - Multiple Procedures
co-payment
Medicaid
Pre-authorization
17. 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
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Categorically needy -MEDICAID
Past - family and social history (PFSH)
Mutually Exclusive Edits
18. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
Long bones
Impacted
-90 - Reference (Outside) Laboratory
Melanin
19. A fat cell
Multigravida
Health Care Financing Administration Common Procedure Coding System
Suicide Attempt
Lipocyte
20. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.
Accident
Dirty claim
MEDICARE Part C
False Claims Act (FCA)
21. forms the roof of the nasal cavity.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Sub classification
Vesicle
Ethmoid Bone
22. Benign growth extending from the surface of the mucous membrane
Past - family and social history (PFSH)
true ribs
Polyp
Established patient
23. 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
Collagen
Health Care Financing Administration Common Procedure Coding System
Spinal/Vertebral Column
circle with a line through it)
24. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Chapters
Electronic Claim
Peer Review Organization (PRO)
Medicare
25. 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.
Rib Cage
Sesamoid bones
Indemnity Insurance
Medicare Claim Status
26. The fractured area of bone collapses on itself.
-26 - Professional Component
Civil Monetary Penalties Law (CMPL)
Compression fracture
triangle (a
27. Numbers 1-7 - attach directly to the sternum in the front of the body.
Birthday rule
triangle (a
Sebaceous glands
true ribs
28. This is not specified as benign or malignant in the diagnosis or medical record.
Unspecified (hypertension)
Occipital Bone
Chief complaint (CC)
Medigap (Medicare Supplemental Insurance)
29. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Keratin
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Primary malignancy
Spinal/Vertebral Column
30. 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.
Medical necessity
Location Methods
MEDICARE Part D
phalanges (phalanx.s)
31. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Relative Value Payment Schedules Method
The Integumentary System
Contracted Rates with MCOs
ulna
32. 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.
TRICARE PLANS
Pre-determination
Non-covered benefit
The Integumentary System
33. 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
Health practitioner
-90 - Reference (Outside) Laboratory
The Good Samaritan Act
Carpals
34. 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
Clearinghouse
MEDICAID COVERAGE
Commercial Carriers
Group Insurance
35. The cuticle at the lower part of the nail and this is sometimes referred to as the
Pre-certification
eponychium
Sections
Long bones
36. 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.
Modifiers
Lipocyte
Medical necessity
Established patient
37. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Established Patient
Location Methods
Complicated
Melanin
38. 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.
Rejected claim
Unauthorized benefit
MEDICARE Part B
New patient
39. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Health Maintenance Organization (HMO)
HCPCS Level I codes
HCPCS Level II codes (National Codes)
Temporal Bone
40. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.
Inpatient
Capitated Rates
Pre-authorization
Vomer
41. Are conditions - situations - and services not covered by the insurance carrier.
Impetigo
Mandible
Exclusions and Limitations
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
42. 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.
appendicular skeleton .
Humerus
Group Provider Number
HCPCS Level I codes
43. Is made up of the shoulder - collar - pelvic and arms and legs
Abuse
-32 - Mandated Services
appendicular skeleton .
Radius
44. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Occipital Bone
Category III Codes CPT
Impetigo
Rejected claim
45. 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 -
Undetermined
Keratin
Unique Provider Identification Number (UPIN)
essential modifiers
46. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Zygoma
Fraud
Colles
Long bones
47. 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
Medicaid
Blue Cross/Blue Shield Plans
Hairline
Invalid claim
48. 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
Performing Provider Identification Number (PPIN)
Pathologic
Vesicle
MEDICARE Part D
49. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Greenstick
Impacted
Pelvis
Colles
50. 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)
False Claims Act (FCA)
co-payment
Lacrimal bones
Unspecified nature