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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.
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. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati
Short bones
MEDICARE Part C
Medicare Claim Status
Maxilla
2. 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.
No ROM
False Claims Act (FCA)
Nodule
Clearinghouse
3. 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.
The Patient Care Partnership (Patient's Bill of Rights)
itemized statement
The St. Anthony Relative Value for Physicians (RVP)
Carpals
4. 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
Blue Cross/Blue Shield Plans
Frontal Bone
Coinsurance
Accept assignment
5. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Occipital Bone
No ROM
Medical Records
Gender rule
6. 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-paid Health Plan
Peer Review Organization (PRO)
Nonparticipating physician
7. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
Fissure
Surgical Package
Physician
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
8. most synarthroses are immovable joints held together by fibrous tissue.
Deductible
Medigap (Medicare Supplemental Insurance)
No ROM
TRICARE PLANS
9. 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.
encounter form
Personal Insurance
encounter form
Inpatient
10. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Sub classification
Flat bones
Coding
Advance Beneficiary Notice
11. The moon like white area at the base of the nail.
lunula
Coding
Medical Records
Multigravida
12. 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'.
Liability insurance
Pre-authorization
Category II Codes CPT
State License Number
13. 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
Location Methods
Exclusions and Limitations
Accident
Alphabetic Index (Volume 2)
14. Forms the anterior part of the skull and the forehead
Frontal Bone
Assault
Pelvis
Vomer
15. 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.
phalanges (phalanx.s)
Inferior nasal conchae
New patient
Evaluation and Management Review
16. 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
Coding
Ischium
Unauthorized benefit
There are three layers to the skin
17. 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
Established Patient
circle with a line through it)
Point-of-Service plan (POS)
Rejected claim
18. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
nonessential modifiers
Patient Confidentiality
Alphabetic Index (Volume 2)
Performing Provider Identification Number (PPIN)
19. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Unauthorized benefit
Two triangular symbols (a
Advance Beneficiary Notice
Pre-determination
20. is defined as one who has not received any medical services within the last three years.
Accept assignment
Flat bones
Chief complaint (CC)
New Patient
21. This is a set of information the physician gathers from the patient regarding the following:
History
TRICARE
Clean claim
Chief complaint
22. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
Indemnity Insurance
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Coding
23. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Advance Beneficiary Notice
Coding
Clearinghouse
Malignant
24. Superior and widest bone
Employee Liability
Comminuted fracture
Pelvis
Surgical Package
25. The poisoning was self-inflicted.
Hypertension Table
Medigap (Medicare Supplemental Insurance)
Electronic Claim
Suicide Attempt
26. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Capitated Rates
Chapters
Compliance Regulations
Abuse
27. Number assigned to the physician by Medicare program.
Unique Provider Identification Number (UPIN)
triangle (a
Carcinoma (Ca) in situ
Clearinghouse
28. Small collection of clear fluid;blister
Categories
Vesicle
TRICARE PLANS
Chapters
29. Indicates add-on codes
Remittance Advice
Chief complaint (CC)
Social Security Number
A plus sign (+)
30. 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
Mandible
A plus sign (+)
Sub classification
TRICARE
31. Contains complete - necessary information - but is incorrect or illogical in some way.
Pathologic
Invalid claim
Temporal Bone
Melanin
32. represents Exemption from the use of modifier -51
Alphabetic Index (Volume 2)
circle with a line through it)
Melanin
Remittance Advice
33. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Paper Claim
Albino
Unlisted Procedures Procedures
34. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Health Insurance Portability and Accountability Act (HIPAA)
Surgical Package
eponychium
Hairline
35. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Evaluation and Management Review
The St. Anthony Relative Value for Physicians (RVP)
Performing Provider Identification Number (PPIN)
Past - family and social history (PFSH)
36. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
National Correct Coding Initiative (NCCI)
Established Patient
Health Maintenance Organization (HMO)
Patient Confidentiality
37. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Commercial Carriers
itemized statement
-99 - Multiple Modifiers
Greenstick
38. 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
Spinal/Vertebral Column
Collagen
MEDICAID COVERAGE
Coordination of Benefits (COB)
39. Is an electronic or paper-based report of payment sent by the payer to the provider.
The Integumentary System
Vesicle
Unspecified nature
Remittance Advice
40. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Clean claim
Coding
Impetigo
41. 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.
Advance Beneficiary Notice
Invalid claim
Personal Insurance
Albino
42. paired bones at the corner of each eye that cradle the tear ducts.
TRICARE PLANS
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Indemnity Insurance
Lacrimal bones
43. 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.
bullet (a
phalanges (phalanx.s)
Assault
Spinal/Vertebral Column
44. numbers 8-10 - are attached to the sternum by cartilage
False ribs
Pre-paid Health Plan
-50 - Bilateral Procedure
Evaluation and Management Review
45. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.
nonessential modifiers
Pre-determination
Health Care Financing Administration Common Procedure Coding System
Inferior nasal conchae
46. Groove or crack like sore
Short bones
Hairline
Fissure
Compression fracture
47. Is the lower medial arm bone.
Deductible
ulna
Participating physician
Inferior nasal conchae
48. Mild or controlled hypertension and no damage to the vascular system or organs.
Performing Provider Identification Number (PPIN)
Benign (hypertension)
Carpals
Fee Schedule
49. Forms the anterior part of the skull and the forehead
Frontal Bone
Health Care Financing Administration Common Procedure Coding System
Eligibility
circle with a line through it)
50. Represents a new procedure or service code added since the previous edition of the manual.
Preferred Provider plan
Maxilla
Fee Schedule
bullet (a