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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
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. Are composed of three-digit codes representing a single disease or condition.
Palatine bones
Categories
Undetermined
Column 1/Column 2 (previously called Comprehensive/Component) Edits
2. Groove or crack like sore
Lacrimal bones
Fissure
Mandible
Occipital Bone
3. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Fee-for-Service
Participating physician
encounter form
Fiscal Intermediary
4. This is a set of information the physician gathers from the patient regarding the following:
The Current Procedural Terminology (CPT)
-32 - Mandated Services
History
Invalid claim
5. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Musculoskeletal System
Hypertension Table
Medically needy
HCPCS Level I codes
6. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
Sebaceous glands
-99 - Multiple Modifiers
Disability insurance
axial skeleton
7. make up part of the roof of the mouth
Add-on codes
Birthday rule
Palatine bones
Rib Cage
8. 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.
New patient
Sebaceous glands
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Retention of Medical Records
9. Describes the services billed and includes a breakdown of how the payment is determined
Palatine bones
Carpals
Paper Claim
Explanation of Benefits (EOB)
10. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual
Paper Claim
Fee Schedule
Employer Liability
Unique Provider Identification Number (UPIN)
11. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fiscal Intermediary
Consultation
Frontal Bone
MEDICARE Part A
12. 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
ulna
Deductible
Capitated Rates
Malignant
13. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Sesamoid bones
Indemnity Insurance
Established Patient
Colles
14. Absence of hair from areas where it normally grows
Fissure
Alopecia
Advance Beneficiary Notice
-51 - Multiple Procedures
15. Represents a new procedure or service code added since the previous edition of the manual.
Palatine bones
Tabular List (Volume 1)...
Review of Systems (ROS)
bullet (a
16. 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.
Maxilla
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
New patient
Nonparticipating physician
17. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Two triangular symbols (a
Unspecified nature
Flat bones
Pre-determination
18. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
Patient Confidentiality
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Established Patient
-50 - Bilateral Procedure
19. Law passed by the federal government to prosecute cases of Medicaid fraud.
-99 - Multiple Modifiers
Fee-for-Service
Employee Liability
Civil Monetary Penalties Law (CMPL)
20. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Category II Codes CPT
Workers Compensation
Greenstick
CPT SECTIONS.
21. major skin pigment
Preferred Provider Organization (PPO)
The Universal Claim Form
Preferred Provider plan
Melanin
22. Structural protein found in the skin and connective tissue
The Current Procedural Terminology (CPT)
Chief complaint
Collagen
Benign
23. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Remittance Advice
Malignant
Peer Review Organization (PRO)
A plus sign (+)
24. Any fracture occurring spontaneously as a result of disease.
MEDICARE Part C
Eligibility
triangle (a
Pathologic
25. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve
premium
Ischium
Accident
Medically needy
26. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Short bones
Coordination of Benefits (COB)
Participating physician
Category I Codes CPT
27. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
TRICARE PLANS
eponychium
Civil Monetary Penalties Law (CMPL)
Inpatient
28. 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
phalanges (phalanx.s)
Capitated Rates
The Universal Claim Form
Gender rule
29. forms the two lower sides of the cranium.
Malignant
Alopecia
-32 - Mandated Services
Temporal Bone
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.
Medically needy
Hypertension Table
Non-covered benefit
Flat bones
31. - 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
Medigap (Medicare Supplemental Insurance)
MEDICARE Part D
Preferred Provider Organization (PPO)
Undetermined
32. 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
A plus sign (+)
Impetigo
TRICARE
TRICARE PLANS
33. Groove or crack like sore
-99 - Multiple Modifiers
Sub classification
Ischium
Fissure
34. open sore on the skin or mucous
Ulcermembranes
Zygoma
Uncertain behavior
Impacted
35. Is the lower medial arm bone.
Chapters
Medically needy
Undetermined
ulna
36. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Wheal
Gangrene
Performing Provider Identification Number (PPIN)
Liability insurance
37.
phalanges (phalanx.s)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
bullet (a
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
38. A fat cell
Hairline
Lipocyte
TRICARE
Point-of-Service plan (POS)
39. 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'.
Ethmoid Bone
Indemnity Insurance
Chief complaint
Pre-authorization
40. 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
Pubic bone
Workers Compensation
Long bones
Carpals
41. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Temporal Bone
Hairline
Category II Codes CPT
Accident
42. Are conditions - situations - and services not covered by the insurance carrier.
The St. Anthony Relative Value for Physicians (RVP)
Review of Systems (ROS)
HCPCS Level I codes
Exclusions and Limitations
43. Make up part of the interior of the nose.
Health Maintenance Organization (HMO)
Inferior nasal conchae
Group Insurance
Humerus
44. Forms the sides of the cranium
Parietal Bones
Modifiers
Assault
Accident
45. 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
Malignant
Categorically needy -MEDICAID
Chapters
Participating physician
46. 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
Workers Compensation
Benign
Birthday rule
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
47. 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.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Chapters
Group Provider Number
Pre-determination
48. 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
There are three layers to the skin
Birthday rule
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Carpals
49. 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
Inferior nasal conchae
Subcategories
Tabular List (Volume 1)...
Maxilla
50. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2
The Current Procedural Terminology (CPT)
Albino
Commercial Carriers
Chapters