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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. 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.
Qualified diagnosis
Fissure
Add-on codes
Retention of Medical Records
2. Is the upper arm bone.
Humerus
Pre-paid Health Plan
Group Provider Number
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
3. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Fraud
Pelvis
Medical necessity
4. Mild or controlled hypertension and no damage to the vascular system or organs.
False Claims Act (FCA)
Physician
TRICARE
Benign (hypertension)
5. 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
Ulcermembranes
Qualified diagnosis
Fraud
Capitated Rates
6. forms the roof of the nasal cavity.
Invalid claim
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Ethmoid Bone
Workers Compensation
7. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin
CPT SECTIONS.
The Integumentary System
true ribs
stand-alone codes
8. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Category I Codes CPT
Hairline
Albino
9. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Flat bones
Malignant
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Fiscal Intermediary
10. 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.
Malignant
National Correct Coding Initiative (NCCI)
Vesicle
Long bones
11. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
appendicular skeleton .
-51 - Multiple Procedures
New patient
Health Care Financing Administration Common Procedure Coding System
12. Describes the services billed and includes a breakdown of how the payment is determined
Gangrene
Collagen
Explanation of Benefits (EOB)
Humerus
13. 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.
Chief complaint
Preferred Provider plan
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Category III Codes CPT
14. paired bones at the corner of each eye that cradle the tear ducts.
False ribs
Social Security Number
Lacrimal bones
Liability insurance
15. 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
Complicated
Lipocyte
History
Preferred Provider Organization (PPO)
16. 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).
Two triangular symbols (a
Fee Schedule
Chapters
Group Insurance
17. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Gender rule
Malignant
Surgical Package
Compliance Regulations
18. Upper jaw bone
Sebaceous glands
Maxilla
MEDICARE Part B
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
19. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Past - family and social history (PFSH)
Polyp
Group practice
Advance Beneficiary Notice
20. 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
Compression fracture
Group Provider Number
Ulcermembranes
Subcategories
21. the bone is crushed and or shattered.
Medical necessity
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Clearinghouse
Comminuted fracture
22. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
encounter form
Pre-determination
MEDICARE Part B
23. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
The Good Samaritan Act
Category I Codes CPT
Medical necessity
Civil Monetary Penalties Law (CMPL)
24. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Assault
Categories
Coordination of Benefits (COB)
25. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
Compliance Regulations
Health practitioner
No ROM
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
26. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
Occipital Bone
Non-covered benefit
Alopecia
-99 - Multiple Modifiers
27. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Chief complaint
Liability insurance
Electronic Claim
Pre-certification
28. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
-32 - Mandated Services
Greenstick
sebaceous(oil) glands and the suddoriferous (sweat) glands
Albino
29. Is made up of the shoulder - collar - pelvic and arms and legs
Coding
appendicular skeleton .
Categorically needy -MEDICAID
Medicare
30. 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
phalanges (phalanx.s)
Flat bones
Inferior nasal conchae
31. 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
co-payment
Compliance Regulations
Health Maintenance Organization (HMO)
Fissure
32. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Consultation
MEDICARE Part A
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Eligibility
33. 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:
ulna
Hypertension Table
Physician
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
34. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Carcinoma (Ca) in situ
Ethmoid Bone
Preferred Provider Organization (PPO)
Eligibility
35. 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
-90 - Reference (Outside) Laboratory
Health Maintenance Organization (HMO)
Relative Value Payment Schedules Method
36. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Assault
HCPCS Level I codes
nonessential modifiers
Past - family and social history (PFSH)
37. 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
Fee-for-Service
Invalid claim
Group Insurance
The Good Samaritan Act
38. Absence of hair from areas where it normally grows
Patient Confidentiality
Comminuted fracture
Alopecia
Gangrene
39. 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.
Parietal Bones
There are three layers to the skin
eponychium
Medical Records
40. Is the lateral lower arm bone (in line with the thumb).
Impetigo
Salter-Harris
Radius
circle with a line through it)
41. Mild or controlled hypertension and no damage to the vascular system or organs.
sprain
Keratin
Benign (hypertension)
Commercial Carriers
42. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
-50 - Bilateral Procedure
Categorically needy -MEDICAID
Category II Codes CPT
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
43. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
New Patient
Peer Review Organization (PRO)
Albino
Malignant
44. are small with irregular shapes. They are found in the wrist and ankle.
Commercial Carriers
Short bones
Impacted
Advance Beneficiary Notice
45. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Commercial Carriers
Employee Liability
Accident
itemized statement
46. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Paper Claim
Chief complaint
Rib Cage
Remittance Advice
47. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Impetigo
Malignant
Civil Monetary Penalties Law (CMPL)
Albino
48. Is a working diagnosis which is not yet established.
Melanin
Retention of Medical Records
Qualified diagnosis
Advance Beneficiary Notice
49. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Pre-paid Health Plan
Mutually Exclusive Edits
Impetigo
50. The fractured area of bone collapses on itself.
Neoplasm Table
Categorically needy -MEDICAID
Compression fracture
Relative Value Payment Schedules Method