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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. 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.
Fiscal Intermediary
False Claims Act (FCA)
Section 3 Index to External Causes of Injury (E codes)
Humerus
2. 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.
Hairline
Sphenoid Bones
Health Insurance Portability and Accountability Act (HIPAA)
itemized statement
3. Cheekbone
Humerus
Zygoma
There are three layers to the skin
Nonparticipating physician
4. Is one who has no contract with the health insurance plan.
Nonparticipating physician
upper appendicular skeleton
Personal Insurance
Sub classification
5. represents Exemption from the use of modifier -51
circle with a line through it)
The Universal Claim Form
Wheal
Physician
6. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Occipital Bone
False Claims Act (FCA)
Categorically needy -MEDICAID
-50 - Bilateral Procedure
7. 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.
Sesamoid bones
Add-on codes
Unauthorized benefit
Retention of Medical Records
8. 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
MEDICARE Part D
Sesamoid bones
Advance Beneficiary Notice
New patient
9. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi
Health practitioner
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Health Maintenance Organization (HMO)
The St. Anthony Relative Value for Physicians (RVP)
10. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Primary malignancy
Malignant
Add-on codes
Pre-certification
11. Consists of the skull - rib cage - and spine
axial skeleton
Evaluation and Management Review
Fee Schedule
Section 3 Index to External Causes of Injury (E codes)
12. 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)...
Salter-Harris
State License Number
Unauthorized benefit
13. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Workers Compensation
History of present illness (HPI)
Explanation of Benefits (EOB)
Employer Identification Number (EIN)
14. 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.
Add-on codes
Pre-authorization
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Capitated Rates
15. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
Fissure
bullet (a
Uncertain behavior
16. 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
Clearinghouse
Full ROM
Unspecified nature
premium
17. This is not specified as benign or malignant in the diagnosis or medical record.
Unspecified (hypertension)
Benign
Column 1/Column 2 (previously called Comprehensive/Component) Edits
TRICARE
18. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Patient Confidentiality
Clearinghouse
Non-covered benefit
Keratin
19. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi
Medicare
Health Maintenance Organization (HMO)
Ethmoid Bone
Limited ROM
20. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin
Pelvis
Rejected claim
HCPCS Level II codes (National Codes)
-51 - Multiple Procedures
21. The cuticle at the lower part of the nail and this is sometimes referred to as the
Evaluation and Management Review
Alopecia
Dirty claim
eponychium
22. 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.
-99 - Multiple Modifiers
Carpals
Point-of-Service plan (POS)
Suicide Attempt
23. 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
Medicare
Hairline
Albino
Fraud
24. 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
Sub classification
Spinal/Vertebral Column
State License Number
Greenstick
25. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
Neoplasm Table
-32 - Mandated Services
Nodule
Impacted
26. 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
Albino
False Claims Act (FCA)
Benign (hypertension)
Medicare
27. 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
Exclusions and Limitations
Occipital Bone
Medigap (Medicare Supplemental Insurance)
Inpatient
28. 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
Review of Systems (ROS)
Coordination of Benefits (COB)
There are three layers to the skin
Pelvis
29. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Coding
premium
Preferred Provider Organization (PPO)
encounter form
30. 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
Hairline
Compression fracture
Established Patient
The Universal Claim Form
31. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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32. 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
upper appendicular skeleton
stand-alone codes
triangle (a
New patient
33. is defined as one who has not received any medical services within the last three years.
The St. Anthony Relative Value for Physicians (RVP)
Spinal/Vertebral Column
Long bones
New Patient
34. 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.
Capitated Rates
Colles
co-payment
sprain
35. 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
Two triangular symbols (a
Coordination of Benefits (COB)
-90 - Reference (Outside) Laboratory
36. 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.
Qualified diagnosis
Retention of Medical Records
Hypertension Table
Group Insurance
37. 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
Rib Cage
Medicare Claim Status
Medical Records
38. numbers 8-10 - are attached to the sternum by cartilage
Clean claim
Lacrimal bones
Medicaid
False ribs
39. Is a working diagnosis which is not yet established.
Qualified diagnosis
Fraud
Indemnity Insurance
Modifiers
40. Poisoning cannot be determined whether intentional or accidental.
Medicare Claim Status
Undetermined
Pelvis
Vomer
41. Noninvasive - non-spreading - nonmalignant
Unspecified (hypertension)
Medicaid
Benign
Dirty claim
42. 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
The Integumentary System
true ribs
Health Maintenance Organization (HMO)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
43. Is an electronic or paper-based report of payment sent by the payer to the provider.
Remittance Advice
HCPCS Level I codes
False Claims Act (FCA)
Commercial Carriers
44. 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'.
Pre-authorization
encounter form
Rib Cage
The Universal Claim Form
45. Superior and widest bone
stand-alone codes
Fee Schedule
Pelvis
Coordination of Benefits (COB)
46. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Albino
Complicated
Coding
Fiscal Intermediary
47. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Greenstick
Non-covered benefit
Consultation
Participating physician
48. Upper jaw bone
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Maxilla
Polyp
Sections
49. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
Ulcermembranes
Sebaceous glands
upper appendicular skeleton
Unauthorized benefit
50. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Inpatient
Fiscal Intermediary
Established patient
essential modifiers