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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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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. 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)
-90 - Reference (Outside) Laboratory
co-payment
Medical necessity
Modifiers
2. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.
Deductible
Abuse
Zygoma
Medicaid
3. major skin pigment
Compression fracture
History
Melanin
Lipocyte
4. Law passed by the federal government to prosecute cases of Medicaid fraud.
Benign (hypertension)
Civil Monetary Penalties Law (CMPL)
Evaluation and Management Review
Compression fracture
5. Are composed of three-digit codes representing a single disease or condition.
Categories
There are two types of sweat glands
CPT SECTIONS.
true ribs
6. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Paper Claim
Alphabetic Index (Volume 2)
Keratin
Point-of-Service plan (POS)
7. open sore on the skin or mucous
Invalid claim
History of present illness (HPI)
co-payment
Ulcermembranes
8. Is the qualifying factor or factors that must be met before a patient receives benefits.
ligaments
Eligibility
Impacted
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
9. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Capitated Rates
Category III Codes CPT
Performing Provider Identification Number (PPIN)
Keratin
10. represents Exemption from the use of modifier -51
axial skeleton
Malignant
circle with a line through it)
Accept assignment
11. 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.
triangle (a
Pre-determination
Preferred Provider plan
-90 - Reference (Outside) Laboratory
12. 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.
Dirty claim
Flat bones
History
MEDICARE Part C
13. 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 -
essential modifiers
Provider Identification Number (PIN)
Sesamoid bones
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
14. Make up part of the interior of the nose.
Malignant
Colles
Inferior nasal conchae
Full ROM
15. 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
Ethmoid Bone
TRICARE
Sub classification
Fissure
16. 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.
encounter form
Medicaid
Occipital Bone
Group Provider Number
17. 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.
Keratin
Ischium
Parietal Bones
phalanges (phalanx.s)
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.
Frontal Bone
Remittance Advice
nonessential modifiers
Disability insurance
19. are small with irregular shapes. They are found in the wrist and ankle.
MEDICARE Part B
Short bones
Unspecified (hypertension)
Categorically needy -MEDICAID
20. 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)
HCPCS Level II codes (National Codes)
Health Care Financing Administration Common Procedure Coding System
Pre-paid Health Plan
co-payment
21. Cheekbone
Hairline
Zygoma
There are two types of sweat glands
-51 - Multiple Procedures
22. 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.
Vomer
triangle (a
Pre-certification
Occipital Bone
23. 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
Exclusions and Limitations
Review of Systems (ROS)
Fee-for-Service
24. 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
Unspecified (hypertension)
Full ROM
The Good Samaritan Act
The Universal Claim Form
25. paired bones at the corner of each eye that cradle the tear ducts.
lunula
Location Methods
Lacrimal bones
Physician
26. 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
appendicular skeleton .
Inpatient
Benign (hypertension)
27. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Disability insurance
MEDICARE Part A
Pathologic
true ribs
28. 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).
Ulcermembranes
Secondary malignancy
History of present illness (HPI)
Sections
29. 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....
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
The St. Anthony Relative Value for Physicians (RVP)
Group Insurance
There are three layers to the skin
30. 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.
Occipital Bone
Fee Schedule
Category III Codes CPT
Exclusions and Limitations
31. Groove or crack like sore
Fissure
HCPCS Level I codes
Unique Provider Identification Number (UPIN)
Clearinghouse
32. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
eponychium
Relative Value Payment Schedules Method
Workers Compensation
-99 - Multiple Modifiers
33. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
ulna
Lipocyte
State License Number
34. open sore on the skin or mucous
Pre-certification
Malignant
Ulcermembranes
Deductible
35. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Health Care Financing Administration Common Procedure Coding System
Medically needy
Full ROM
Vomer
36. 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
Remittance Advice
Coordination of Benefits (COB)
Paper Claim
triangle (a
37. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Non-covered benefit
Frontal Bone
Musculoskeletal System
Carpals
38. 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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39. Forms the sides of the cranium
Medicaid
Parietal Bones
Participating physician
phalanges (phalanx.s)
40. requires investigation and needs further clarification.
Dirty claim
Pelvis
Health practitioner
Rejected claim
41. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Polyp
-90 - Reference (Outside) Laboratory
Dirty claim
Musculoskeletal System
42. 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.
MEDICARE Part B
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
National Correct Coding Initiative (NCCI)
Mandible
43. 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.
Pre-certification
Sections
Modifiers
Sebaceous glands
44. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.
-51 - Multiple Procedures
Physician
nonessential modifiers
History
45. 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.
Preferred Provider plan
-51 - Multiple Procedures
Malignant
Sesamoid bones
46. Number assigned to the physician by Medicare program.
Clearinghouse
Unique Provider Identification Number (UPIN)
Coinsurance
Employer Liability
47. 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
The Universal Claim Form
The Good Samaritan Act
48. 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
The Good Samaritan Act
Short bones
essential modifiers
49. 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
Radius
Group Insurance
Nonparticipating physician
Inferior nasal conchae
50. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
Categorically needy -MEDICAID
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Established Patient
Pre-determination