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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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 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.
phalanges (phalanx.s)
Relative Value Payment Schedules Method
Sections
Gangrene
2. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Category III Codes CPT
Gangrene
Full ROM
3. death of tissue associated with loss of blood supply
Category III Codes CPT
The St. Anthony Relative Value for Physicians (RVP)
triangle (a
Gangrene
4. 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
Polyp
Nonparticipating physician
Patient Confidentiality
5. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
stand-alone codes
-99 - Multiple Modifiers
Contracted Rates with MCOs
Deductible
6. anterior to the temporal bones.
Evaluation and Management Review
There are two types of sweat glands
Sphenoid Bones
Lacrimal bones
7. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
Impacted
Alphabetic Index (Volume 2)
-50 - Bilateral Procedure
Group Insurance
8. Groove or crack like sore
Sections
Surgical Package
Fissure
appendicular skeleton .
9. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
triangle (a
Participating physician
co-payment
National Correct Coding Initiative (NCCI)
10. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Lipocyte
-32 - Mandated Services
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
11. death of tissue associated with loss of blood supply
Zygoma
Chief complaint (CC)
Established patient
Gangrene
12. 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.
Category III Codes CPT
Unspecified nature
lunula
eponychium
13. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Social Security Number
Hairline
Employer Identification Number (EIN)
Peer Review Organization (PRO)
14. 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
Commercial Carriers
Palatine bones
Employer Liability
Reasons for Documentation
15. 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.
Rejected claim
Group Provider Number
Coinsurance
Secondary malignancy
16. Any fracture occurring spontaneously as a result of disease.
Pathologic
Employer Liability
Flat bones
Accept assignment
17. 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.
Benign (hypertension)
Neoplasm Table
Frontal Bone
Clean claim
18. Is the lower medial arm bone.
There are two types of sweat glands
ulna
Social Security Number
Retention of Medical Records
19. 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
Unspecified nature
Accident
-26 - Professional Component
Medical Records
20. forms the two lower sides of the cranium.
Capitated Rates
There are two types of sweat glands
Temporal Bone
Health Insurance Portability and Accountability Act (HIPAA)
21. 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.
true ribs
MEDICARE Part D
Pre-certification
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
22. 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
Section 3 Index to External Causes of Injury (E codes)
Medicaid
Clearinghouse
Medical Records
23. Typically not used on the claim form unless the provider does not have an EIN.
Social Security Number
Ischium
Performing Provider Identification Number (PPIN)
Pre-authorization
24. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
The Good Samaritan Act
Temporal Bone
premium
25. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
The Patient Care Partnership (Patient's Bill of Rights)
Workers Compensation
Carpals
Mutually Exclusive Edits
26. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Capitated Rates
Advance Beneficiary Notice
Flat bones
Carpals
27. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
true ribs
Reasons for Documentation
Compliance Regulations
Employer Identification Number (EIN)
28. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
Capitated Rates
The Universal Claim Form
Inferior nasal conchae
Disability insurance
29. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Chapters
Secondary malignancy
Lipocyte
Fissure
30. 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
Accept assignment
Benign
Coinsurance
Abuse
31. Number assigned by the insurance company to a physician who renders services to patients.
Provider Identification Number (PIN)
-51 - Multiple Procedures
Keratin
MEDICARE Part D
32. 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
Section 3 Index to External Causes of Injury (E codes)
Outpatient
New Patient
bullet (a
33. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
Personal Insurance
The St. Anthony Relative Value for Physicians (RVP)
New patient
-50 - Bilateral Procedure
34. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Palatine bones
-50 - Bilateral Procedure
HCPCS Level I codes
There are two types of sweat glands
35. Number assigned by the insurance company to a physician who renders services to patients.
Performing Provider Identification Number (PPIN)
Secondary malignancy
Patient Confidentiality
Provider Identification Number (PIN)
36. Most billing-related cases are based on HIPAA and False Claims Act.
A plus sign (+)
Compliance Regulations
Explanation of Benefits (EOB)
Comminuted fracture
37. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Established patient
Fiscal Intermediary
Undetermined
38. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Mutually Exclusive Edits
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Medical necessity
A plus sign (+)
39. 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
HCPCS Level II codes (National Codes)
Coordination of Benefits (COB)
Dirty claim
40. 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
Blue Cross/Blue Shield Plans
There are three layers to the skin
phalanges (phalanx.s)
Coding
41. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Assault
Parietal Bones
Medicare
Subcategories
42. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Medicaid
MEDICARE Part A
itemized statement
Paper Claim
43. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
upper appendicular skeleton
Abuse
Medigap (Medicare Supplemental Insurance)
Group Insurance
44. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Ethmoid Bone
Salter-Harris
Sub classification
Coordination of Benefits (COB)
45. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
ulna
Long bones
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Medigap (Medicare Supplemental Insurance)
46. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
-90 - Reference (Outside) Laboratory
Group Insurance
Employer Liability
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
47. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Spinal/Vertebral Column
Hypertension Table
Explanation of Benefits (EOB)
48. A fat cell
sebaceous(oil) glands and the suddoriferous (sweat) glands
Capitated Rates
Macule
Lipocyte
49. Deficient in pigment (melanin)
Full ROM
Radius
Sebaceous glands
Albino
50. Are composed of three-digit codes representing a single disease or condition.
Mutually Exclusive Edits
Vomer
Fissure
Categories