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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. 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
False ribs
Category II Codes CPT
premium
Preferred Provider Organization (PPO)
2. 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
Two triangular symbols (a
Medical Records
The Universal Claim Form
Employer Liability
3. Is the lateral lower arm bone (in line with the thumb).
Polyp
HCPCS Level I codes
Radius
Add-on codes
4. 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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5. This is not specified as benign or malignant in the diagnosis or medical record.
Category I Codes CPT
Unspecified (hypertension)
The Universal Claim Form
Polyp
6. 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
Chief complaint (CC)
There are three layers to the skin
appendicular skeleton .
Paper Claim
7. Noninvasive - non-spreading - nonmalignant
Clean claim
ligaments
Maxilla
Benign
8. 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.
History
Personal Insurance
Compliance Regulations
MEDICARE Part C
9. make up part of the roof of the mouth
Palatine bones
upper appendicular skeleton
Nonparticipating physician
Albino
10. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Two triangular symbols (a
Medicare
Musculoskeletal System
There are three layers to the skin
11. 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
Humerus
-90 - Reference (Outside) Laboratory
Preferred Provider plan
MEDICAID COVERAGE
12. 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.
Advance Beneficiary Notice
Unique Provider Identification Number (UPIN)
Chapters
False Claims Act (FCA)
13. is defined as one who has not received any medical services within the last three years.
New Patient
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Spinal/Vertebral Column
Categories
14. numbers 8-10 - are attached to the sternum by cartilage
False ribs
Impacted
Colles
co-payment
15. - 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
Accident
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Birthday rule
Medigap (Medicare Supplemental Insurance)
16. 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).
Sections
true ribs
TRICARE PLANS
Abuse
17. Number assigned by the insurance company to a physician who renders services to patients.
Multigravida
Provider Identification Number (PIN)
New patient
Comminuted fracture
18. 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.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Medigap (Medicare Supplemental Insurance)
Preferred Provider plan
Accident
19. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati
Accident
Primary malignancy
Capitated Rates
Sections
20. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
Fraud
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Macule
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
21. Discolored - flat lesion (freckles - tattoo marks)
Macule
Qualified diagnosis
Carpals
Health Care Financing Administration Common Procedure Coding System
22. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Pre-paid Health Plan
Exclusions and Limitations
HCPCS Level I codes
Add-on codes
23. The lower anterior part of the bone
Pubic bone
Accident
circle with a line through it)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
24. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Reasons for Documentation
sebaceous(oil) glands and the suddoriferous (sweat) glands
MEDICARE Part A
Maxilla
25. Any fracture occurring spontaneously as a result of disease.
Benign
Employer Identification Number (EIN)
Pathologic
Gender rule
26. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
CPT SECTIONS.
Radius
Maxilla
upper appendicular skeleton
27. major skin pigment
Primary malignancy
Mutually Exclusive Edits
Vomer
Melanin
28. represents Exemption from the use of modifier -51
The Good Samaritan Act
New patient
Group Provider Number
circle with a line through it)
29. 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
Alopecia
Eligibility
ligaments
Carpals
30. 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.
Non-covered benefit
Coordination of Benefits (COB)
Category I Codes CPT
Electronic Claim
31. uncertain whether benign or malignant; borderline malignancy
Uncertain behavior
Category II Codes CPT
Indemnity Insurance
Workers Compensation
32. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
MEDICAID COVERAGE
Keratin
Categorically needy -MEDICAID
Outpatient
33. 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.
Medigap (Medicare Supplemental Insurance)
MEDICARE Part B
False Claims Act (FCA)
Section 3 Index to External Causes of Injury (E codes)
34. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Surgical Package
Liability insurance
Full ROM
Ulcermembranes
35. Are composed of three-digit codes representing a single disease or condition.
Capitated Rates
Employer Liability
Categories
Carpals
36. Absence of hair from areas where it normally grows
Non-covered benefit
MEDICARE Part C
Unique Provider Identification Number (UPIN)
Alopecia
37. solid - round or oval elevated lesion more than 1 cm in diameter
Coordination of Benefits (COB)
Nodule
Mandible
Pubic bone
38. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Lacrimal bones
Surgical Package
Keratin
Medigap (Medicare Supplemental Insurance)
39. is a traumatic injury to a joint involving the soft tissue.
sprain
Ethmoid Bone
Established patient
Flat bones
40. Contains complete - necessary information - but is incorrect or illogical in some way.
Unspecified nature
Inferior nasal conchae
Invalid claim
Fissure
41. anterior to the temporal bones.
Parietal Bones
Wheal
Sphenoid Bones
Reasons for Documentation
42. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Parietal Bones
Pathologic
Accept assignment
Medically needy
43. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Colles
Vomer
Qualified diagnosis
National Correct Coding Initiative (NCCI)
44. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Sebaceous glands
-51 - Multiple Procedures
TRICARE PLANS
Fissure
45. poisoning was inflicted by another person with intent to kill or injure
Section 3 Index to External Causes of Injury (E codes)
Dirty claim
Salter-Harris
Assault
46. 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.
Established Patient
Medical Records
Chapters
Pre-determination
47. The reason the patient came to see the physician.
nonessential modifiers
Albino
Chief complaint (CC)
History
48. 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
Ischium
eponychium
TRICARE
Musculoskeletal System
49. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.
Inferior nasal conchae
Nonparticipating physician
Primary malignancy
triangle (a
50. Numbers 1-7 - attach directly to the sternum in the front of the body.
true ribs
Malignant
Group Insurance
Medicare Claim Status