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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. Most billing-related cases are based on HIPAA and False Claims Act.
Advance Beneficiary Notice
Medical Records
Preferred Provider Organization (PPO)
Compliance Regulations
2. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Blue Cross/Blue Shield Plans
Hairline
TRICARE PLANS
Deductible
3. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.
Gender rule
Unique Provider Identification Number (UPIN)
TRICARE
Colles
4. This is the inventory of the constitutional symptoms regarding the various body systems.
-99 - Multiple Modifiers
Hypertension Table
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Review of Systems (ROS)
5. 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
Location Methods
Capitated Rates
Two triangular symbols (a
The St. Anthony Relative Value for Physicians (RVP)
6. 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
Vomer
stand-alone codes
Assault
7. - 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
Pathologic
Wheal
Medigap (Medicare Supplemental Insurance)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
8. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Location Methods
Preferred Provider plan
Modifiers
9. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
New Patient
Medical necessity
co-payment
Vomer
10. The poisoning was self-inflicted.
Albino
Neoplasm Table
Suicide Attempt
Employer Identification Number (EIN)
11. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Medical Records
Impetigo
Benign (hypertension)
Vesicle
12. Produce secretions that allow the body to be moisturized or cooled.
Unauthorized benefit
-32 - Mandated Services
sebaceous(oil) glands and the suddoriferous (sweat) glands
Hypertension Table
13. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
phalanges (phalanx.s)
Nonparticipating physician
Advance Beneficiary Notice
premium
14. 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)
Review of Systems (ROS)
Salter-Harris
The Universal Claim Form
15. 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.
encounter form
triangle (a
Assault
State License Number
16. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
New Patient
Ischium
Radius
Abuse
17. anterior to the temporal bones.
Subcategories
Sphenoid Bones
Disability insurance
Contracted Rates with MCOs
18. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Remittance Advice
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Fiscal Intermediary
Compliance Regulations
19. Forms the sides of the cranium
Parietal Bones
Compliance Regulations
Health Care Financing Administration Common Procedure Coding System
Commercial Carriers
20. 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
Accident
Wheal
-51 - Multiple Procedures
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
21. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Uncertain behavior
Pre-determination
Ulcermembranes
Full ROM
22. 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.
phalanges (phalanx.s)
False ribs
The St. Anthony Relative Value for Physicians (RVP)
Dirty claim
23. 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
circle with a line through it)
Secondary malignancy
Pathologic
24. forms the roof of the nasal cavity.
-26 - Professional Component
Ethmoid Bone
Indemnity Insurance
Employer Identification Number (EIN)
25. Is the qualifying factor or factors that must be met before a patient receives benefits.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Musculoskeletal System
Performing Provider Identification Number (PPIN)
Eligibility
26. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Medicare
Relative Value Payment Schedules Method
Ulcermembranes
Categories
27. 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.
Review of Systems (ROS)
Ulcermembranes
Sesamoid bones
bullet (a
28. 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
Category II Codes CPT
Sub classification
Pre-authorization
29. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Musculoskeletal System
sprain
Suicide Attempt
Malignant
30. 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)
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Personal Insurance
Full ROM
31. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
Established patient
Commercial Carriers
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Malignant
32. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Group Provider Number
Gender rule
Employer Liability
33. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Unauthorized benefit
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Section 3 Index to External Causes of Injury (E codes)
Mutually Exclusive Edits
34. 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
Social Security Number
Undetermined
Neoplasm Table
Unlisted Procedures Procedures
35. paired bones at the corner of each eye that cradle the tear ducts.
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Malignant
Preferred Provider Organization (PPO)
Lacrimal bones
36. The cuticle at the lower part of the nail and this is sometimes referred to as the
eponychium
History
encounter form
Keratin
37. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
-90 - Reference (Outside) Laboratory
appendicular skeleton .
Undetermined
Impetigo
38. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Consultation
Temporal Bone
Fee-for-Service
39. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Macule
Fiscal Intermediary
TRICARE
Complicated
40. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Compression fracture
Provider Identification Number (PIN)
Group Insurance
41. 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.
Section 3 Index to External Causes of Injury (E codes)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Spinal/Vertebral Column
Group Provider Number
42. 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
Abuse
Pathologic
The Good Samaritan Act
Liability insurance
43. 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
Unspecified nature
Blue Cross/Blue Shield Plans
There are two types of sweat glands
No ROM
44. Is the lower medial arm bone.
Medical necessity
Accident
The St. Anthony Relative Value for Physicians (RVP)
ulna
45. 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
History
National Correct Coding Initiative (NCCI)
Neoplasm Table
TRICARE PLANS
46. 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
Unlisted Procedures Procedures
Abuse
Maxilla
Rejected claim
47. Structural protein found in the skin and connective tissue
Collagen
Category III Codes CPT
lunula
Rib Cage
48. Represents a new procedure or service code added since the previous edition of the manual.
bullet (a
History
Evaluation and Management Review
Past - family and social history (PFSH)
49. solid - round or oval elevated lesion more than 1 cm in diameter
Nodule
Suicide Attempt
Impetigo
axial skeleton
50. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
appendicular skeleton .
Suicide Attempt
Personal Insurance
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