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Test your basic knowledge |
Medical Billing And Coding Vocab
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Study First
Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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. Structural protein found in the skin and connective tissue
The Universal Claim Form
Ischium
Collagen
Medicare
2. 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....
Peer Review Organization (PRO)
Zygoma
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Established patient
3. 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
Mutually Exclusive Edits
Rib Cage
Sphenoid Bones
4. 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
Capitated Rates
Secondary malignancy
Hairline
Established patient
5. Is one who has no contract with the health insurance plan.
A plus sign (+)
Nonparticipating physician
Medicare
Accident
6. 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
essential modifiers
Ulcermembranes
-26 - Professional Component
7. This is a set of information the physician gathers from the patient regarding the following:
Categorically needy -MEDICAID
Physician
History
upper appendicular skeleton
8. 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
Sesamoid bones
stand-alone codes
Pubic bone
Sebaceous glands
9. 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
Spinal/Vertebral Column
Point-of-Service plan (POS)
Location Methods
MEDICARE Part C
10. 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.
Lipocyte
Short bones
Medicare Claim Status
Mutually Exclusive Edits
11. Number assigned by the insurance company to a physician who renders services to patients.
Salter-Harris
essential modifiers
Compression fracture
Provider Identification Number (PIN)
12. Contains complete - necessary information - but is incorrect or illogical in some way.
Invalid claim
Compliance Regulations
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Fraud
13. 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.
Qualified diagnosis
Medicare Claim Status
Mandible
Dirty claim
14. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
False Claims Act (FCA)
Keratin
Sections
upper appendicular skeleton
15. Make up part of the interior of the nose.
upper appendicular skeleton
Inferior nasal conchae
Lipocyte
Malignant
16. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Social Security Number
Medicare Claim Status
TRICARE
Tabular List (Volume 1)...
17. Is a working diagnosis which is not yet established.
Indemnity Insurance
Qualified diagnosis
premium
Exclusions and Limitations
18. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Consultation
Nodule
Carpals
The Good Samaritan Act
19. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
MEDICARE Part A
premium
There are three layers to the skin
Nonparticipating physician
20. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Health Maintenance Organization (HMO)
New patient
Established Patient
21. 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
Malignant
Malignant
Performing Provider Identification Number (PPIN)
Health Maintenance Organization (HMO)
22. 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
ligaments
MEDICARE Part C
Undetermined
Carpals
23. Is when two insurance companies work together to coordinate payment of the benefits.
Primary malignancy
Coordination of Benefits (COB)
Benign (hypertension)
Multigravida
24. 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
Coding
Paper Claim
Melanin
triangle (a
25. Number assigned to the physician by Medicare program.
Categories
Unique Provider Identification Number (UPIN)
Blue Cross/Blue Shield Plans
Pubic bone
26. The poisoning was self-inflicted.
Location Methods
Suicide Attempt
Spinal/Vertebral Column
Pre-determination
27. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
Health Maintenance Organization (HMO)
Relative Value Payment Schedules Method
Keratin
CPT SECTIONS.
28. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
nonessential modifiers
Rib Cage
Lipocyte
Secondary malignancy
29. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
Unlisted Procedures Procedures
Evaluation and Management Review
eponychium
Retention of Medical Records
30. The poisoning was self-inflicted.
Liability insurance
Temporal Bone
Suicide Attempt
Impetigo
31. 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
Flat bones
Modifiers
Employee Liability
32. 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).
Pubic bone
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Consultation
Sections
33. 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
nonessential modifiers
Employee Liability
TRICARE
Vomer
34. 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
true ribs
Fraud
circle with a line through it)
35. 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
Unlisted Procedures Procedures
sebaceous(oil) glands and the suddoriferous (sweat) glands
Point-of-Service plan (POS)
There are three layers to the skin
36. Typically not used on the claim form unless the provider does not have an EIN.
The Universal Claim Form
Employee Liability
Greenstick
Social Security Number
37. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
The Good Samaritan Act
co-payment
Flat bones
Rib Cage
38. 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....
ligaments
Provider Identification Number (PIN)
Established patient
Employer Identification Number (EIN)
39. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
-26 - Professional Component
Impetigo
Macule
Alphabetic Index (Volume 2)
40. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin
-51 - Multiple Procedures
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Full ROM
Reasons for Documentation
41. 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)
true ribs
co-payment
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Malignant
42. 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.
itemized statement
circle with a line through it)
Pre-determination
The Good Samaritan Act
43.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Fee Schedule
Provider Identification Number (PIN)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
44. 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
Radius
Subcategories
Preferred Provider Organization (PPO)
HCPCS Level I codes
45. 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
nonessential modifiers
Health practitioner
Sub classification
Malignant
46. 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
Unauthorized benefit
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
History of present illness (HPI)
47. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
ligaments
Unlisted Procedures Procedures
Retention of Medical Records
Primary malignancy
48. solid - round or oval elevated lesion more than 1 cm in diameter
Retention of Medical Records
Nodule
Location Methods
Clean claim
49. numbers 8-10 - are attached to the sternum by cartilage
Spinal/Vertebral Column
The Good Samaritan Act
False ribs
Category III Codes CPT
50. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu
Benign (hypertension)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Neoplasm Table
Patient Confidentiality