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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. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
-50 - Bilateral Procedure
Vesicle
Modifiers
Personal Insurance
2. solid - round or oval elevated lesion more than 1 cm in diameter
Civil Monetary Penalties Law (CMPL)
itemized statement
nonessential modifiers
Nodule
3. 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
Disability insurance
State License Number
Contracted Rates with MCOs
4. 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
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Categorically needy -MEDICAID
Point-of-Service plan (POS)
Preferred Provider Organization (PPO)
5. 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.
Zygoma
Assault
Sections
Add-on codes
6. 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).
The Current Procedural Terminology (CPT)
Chapters
Ischium
sprain
7. Structural protein found in the skin and connective tissue
itemized statement
Pelvis
Collagen
False Claims Act (FCA)
8. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Indemnity Insurance
Deductible
Chief complaint (CC)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
9. This modifier is used when the same procedure is performed on a mirror-image part of the body..
triangle (a
Flat bones
-50 - Bilateral Procedure
Salter-Harris
10. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Lipocyte
Health Insurance Portability and Accountability Act (HIPAA)
Chief complaint (CC)
11. 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.
triangle (a
New patient
stand-alone codes
Inferior nasal conchae
12. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.
Workers Compensation
Unique Provider Identification Number (UPIN)
Inpatient
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
13. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Carcinoma (Ca) in situ
Preferred Provider Organization (PPO)
Coinsurance
Sebaceous glands
14. poisoning was inflicted by another person with intent to kill or injure
Assault
Comminuted fracture
Medicaid
co-payment
15. The lower anterior part of the bone
Disability insurance
Pubic bone
Social Security Number
Sub classification
16. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Reasons for Documentation
Lipocyte
Parietal Bones
phalanges (phalanx.s)
17. 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
Sub classification
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Fraud
-51 - Multiple Procedures
18. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
bullet (a
Established patient
Fraud
Deductible
19. Pre-determined set of benefits covered under one set annual fee.
Pre-paid Health Plan
The Integumentary System
Health practitioner
Pelvis
20. the bone is crushed and or shattered.
Vesicle
Eligibility
Comminuted fracture
Compliance Regulations
21. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Health practitioner
Humerus
bullet (a
Reasons for Documentation
22. 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.
Reasons for Documentation
Group Provider Number
triangle (a
History
23. Make up part of the interior of the nose.
Inferior nasal conchae
Wheal
Two triangular symbols (a
Compliance Regulations
24. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
Provider Identification Number (PIN)
MEDICARE Part A
MEDICARE Part C
Employee Liability
25. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Category II Codes CPT
MEDICARE Part B
Blue Cross/Blue Shield Plans
Carcinoma (Ca) in situ
26. 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
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
sebaceous(oil) glands and the suddoriferous (sweat) glands
Comminuted fracture
triangle (a
27. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
premium
The St. Anthony Relative Value for Physicians (RVP)
Birthday rule
Impetigo
28. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Unauthorized benefit
Compression fracture
Flat bones
Modifiers
29. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
Long bones
Health practitioner
true ribs
30. The bone is broken and pierces an internal organ
Complicated
Benign (hypertension)
Hairline
Preferred Provider Organization (PPO)
31. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Spinal/Vertebral Column
Impetigo
Coding
Liability insurance
32. The lower anterior part of the bone
eponychium
Health Insurance Portability and Accountability Act (HIPAA)
Review of Systems (ROS)
Pubic bone
33. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Disability insurance
Melanin
A plus sign (+)
34. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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35. 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.
Location Methods
Secondary malignancy
Pre-determination
Group Provider Number
36. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
The Good Samaritan Act
-90 - Reference (Outside) Laboratory
Secondary malignancy
Fraud
37. Groove or crack like sore
Carpals
Relative Value Payment Schedules Method
Salter-Harris
Fissure
38. Typically not used on the claim form unless the provider does not have an EIN.
Polyp
Category I Codes CPT
Carcinoma (Ca) in situ
Social Security Number
39. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Point-of-Service plan (POS)
Contracted Rates with MCOs
-51 - Multiple Procedures
40. 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.
Reasons for Documentation
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Medicaid
Alphabetic Index (Volume 2)
41. forms the roof of the nasal cavity.
Ethmoid Bone
Accident
Past - family and social history (PFSH)
Unspecified nature
42. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Spinal/Vertebral Column
Inferior nasal conchae
Group Insurance
43. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
Rejected claim
Paper Claim
The Current Procedural Terminology (CPT)
sebaceous(oil) glands and the suddoriferous (sweat) glands
44. 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
stand-alone codes
Ulcermembranes
Accident
Medicare Claim Status
45. 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)
bullet (a
Malignant
Occipital Bone
46. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
appendicular skeleton .
Neoplasm Table
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
47. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Accept assignment
ligaments
History of present illness (HPI)
Clearinghouse
48. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
Alphabetic Index (Volume 2)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Paper Claim
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
49. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Remittance Advice
-51 - Multiple Procedures
premium
Malignant
50. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
Subcategories
The Integumentary System
Fee Schedule
HCPCS Level II codes (National Codes)
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