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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.
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. 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
Greenstick
Physician
Medigap (Medicare Supplemental Insurance)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
2. 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.
Pre-authorization
Group Provider Number
Point-of-Service plan (POS)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
3. - 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)
Salter-Harris
Eligibility
Group Provider Number
4. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Albino
Medical necessity
Compression fracture
Sub classification
5. Any fracture occurring spontaneously as a result of disease.
Pathologic
Non-covered benefit
Complicated
Undetermined
6. forms the two lower sides of the cranium.
Non-covered benefit
Temporal Bone
Palatine bones
Inpatient
7. 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
Musculoskeletal System
Medically needy
New patient
Fraud
8. uncertain whether benign or malignant; borderline malignancy
stand-alone codes
bullet (a
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Uncertain behavior
9. poisoning was inflicted by another person with intent to kill or injure
Assault
State License Number
Blue Cross/Blue Shield Plans
circle with a line through it)
10. Produce secretions that allow the body to be moisturized or cooled.
sebaceous(oil) glands and the suddoriferous (sweat) glands
Advance Beneficiary Notice
Add-on codes
Zygoma
11. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
No ROM
Limited ROM
Unspecified (hypertension)
Consultation
12. 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.
Pubic bone
-32 - Mandated Services
Performing Provider Identification Number (PPIN)
Coinsurance
13. .. lower jaw bone.
Modifiers
Mandible
sebaceous(oil) glands and the suddoriferous (sweat) glands
Full ROM
14. 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....
Outpatient
Fee-for-Service
Established patient
Lipocyte
15. Noninvasive - non-spreading - nonmalignant
Benign
Fraud
MEDICARE Part C
Review of Systems (ROS)
16. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
sebaceous(oil) glands and the suddoriferous (sweat) glands
Colles
Sebaceous glands
Short bones
17. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Sebaceous glands
Qualified diagnosis
Melanin
circle with a line through it)
18. Contains complete - necessary information - but is incorrect or illogical in some way.
Invalid claim
Chapters
The Good Samaritan Act
HCPCS Level II codes (National Codes)
19. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Medicare Claim Status
Explanation of Benefits (EOB)
Lacrimal bones
Disability insurance
20. 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
Mutually Exclusive Edits
Ethmoid Bone
Relative Value Payment Schedules Method
Past - family and social history (PFSH)
21. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Subcategories
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Chief complaint
Established Patient
22. 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.
Medicaid
Multigravida
Relative Value Payment Schedules Method
Coding
23. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela
Two triangular symbols (a
History
There are three layers to the skin
Relative Value Payment Schedules Method
24. Is the lower medial arm bone.
ulna
Rib Cage
Outpatient
Humerus
25. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
encounter form
Invalid claim
Accept assignment
26. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Uncertain behavior
Pre-certification
Medical necessity
The Good Samaritan Act
27. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
CPT SECTIONS.
Unspecified nature
Medicare
28. 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)
co-payment
New patient
Humerus
Category III Codes CPT
29. open sore on the skin or mucous
Ulcermembranes
Health Care Financing Administration Common Procedure Coding System
Indemnity Insurance
lunula
30. 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.
Colles
sebaceous(oil) glands and the suddoriferous (sweat) glands
Retention of Medical Records
Macule
31. Forms the anterior part of the skull and the forehead
Category I Codes CPT
Compression fracture
Remittance Advice
Frontal Bone
32. 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
Unauthorized benefit
Category II Codes CPT
Past - family and social history (PFSH)
Relative Value Payment Schedules Method
33. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages
Ethmoid Bone
Liability insurance
Undetermined
Impacted
34. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
ulna
Deductible
-50 - Bilateral Procedure
Category I Codes CPT
35. Upper jaw bone
Maxilla
Participating physician
The Patient Care Partnership (Patient's Bill of Rights)
Categorically needy -MEDICAID
36. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Performing Provider Identification Number (PPIN)
Coinsurance
Provider Identification Number (PIN)
stand-alone codes
37. 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
Coordination of Benefits (COB)
Wheal
Multigravida
38. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Capitated Rates
MEDICARE Part A
There are two types of sweat glands
39. 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
encounter form
Compression fracture
False ribs
Fraud
40. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
Fee-for-Service
Keratin
Liability insurance
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
41. 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
Gender rule
The Integumentary System
MEDICARE Part C
42. Number assigned by the insurance company to a physician who renders services to patients.
Personal Insurance
Preferred Provider Organization (PPO)
Provider Identification Number (PIN)
Paper Claim
43. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
MEDICARE Part A
Chapters
Health Insurance Portability and Accountability Act (HIPAA)
Medicare Claim Status
44. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules
Benign (hypertension)
Employer Identification Number (EIN)
Pelvis
Fee-for-Service
45. 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.
Physician
Long bones
premium
Benign (hypertension)
46. 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.
sprain
Point-of-Service plan (POS)
Sesamoid bones
Modifiers
47. 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
Occipital Bone
Commercial Carriers
Retention of Medical Records
Point-of-Service plan (POS)
48. Small collection of clear fluid;blister
Categories
Vesicle
Dirty claim
Rib Cage
49. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Parietal Bones
Hypertension Table
Medical necessity
50. 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
-99 - Multiple Modifiers
Sebaceous glands
Capitated Rates
MEDICARE Part C