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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. 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.
Non-covered benefit
Unique Provider Identification Number (UPIN)
Benign (hypertension)
stand-alone codes
2. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Spinal/Vertebral Column
Limited ROM
Sub classification
Two triangular symbols (a
3. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Medically needy
Birthday rule
Consultation
Unspecified nature
4. Upper jaw bone
Benign (hypertension)
Maxilla
Category I Codes CPT
essential modifiers
5. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp
Health Insurance Portability and Accountability Act (HIPAA)
Performing Provider Identification Number (PPIN)
MEDICAID COVERAGE
Location Methods
6. 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.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Section 3 Index to External Causes of Injury (E codes)
National Correct Coding Initiative (NCCI)
Outpatient
7.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Primary malignancy
true ribs
sebaceous(oil) glands and the suddoriferous (sweat) glands
8. 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
Medicare Claim Status
Liability insurance
Keratin
Abuse
9. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Workers Compensation
Modifiers
Accept assignment
The Universal Claim Form
10. 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
MEDICARE Part A
Paper Claim
Disability insurance
Past - family and social history (PFSH)
11. .. lower jaw bone.
Mandible
Alopecia
There are three layers to the skin
Explanation of Benefits (EOB)
12. 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
Compliance Regulations
Commercial Carriers
-26 - Professional Component
Medical Records
13. Is a working diagnosis which is not yet established.
Medicaid
Qualified diagnosis
Commercial Carriers
Impacted
14. 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.
Liability insurance
Neoplasm Table
MEDICARE Part C
Retention of Medical Records
15. poisoning was inflicted by another person with intent to kill or injure
Group Insurance
Unspecified (hypertension)
Disability insurance
Assault
16. major skin pigment
Melanin
TRICARE PLANS
Personal Insurance
Employer Identification Number (EIN)
17. .. lower jaw bone.
Established Patient
Melanin
Mandible
Clean claim
18. Is the lower medial arm bone.
ulna
Carcinoma (Ca) in situ
encounter form
Full ROM
19. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
The St. Anthony Relative Value for Physicians (RVP)
Clean claim
Coding
Evaluation and Management Review
20. 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.
Qualified diagnosis
Medicare Claim Status
No ROM
A plus sign (+)
21. 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
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Qualified diagnosis
Unspecified (hypertension)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
22. 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
Point-of-Service plan (POS)
Zygoma
Impacted
Reasons for Documentation
23. Any fracture occurring spontaneously as a result of disease.
Pathologic
Category II Codes CPT
axial skeleton
appendicular skeleton .
24. Contains complete - necessary information - but is incorrect or illogical in some way.
Personal Insurance
Eligibility
Invalid claim
Secondary malignancy
25. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
Compliance Regulations
Unspecified (hypertension)
ligaments
Blue Cross/Blue Shield Plans
26. 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
Past - family and social history (PFSH)
Group Provider Number
bullet (a
Patient Confidentiality
27. Represent changes in the text or definition between the triangles.
Melanin
Commercial Carriers
Two triangular symbols (a
Surgical Package
28. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medically needy
Non-covered benefit
Malignant
Past - family and social history (PFSH)
29. is defined as one who has not received any medical services within the last three years.
Sesamoid bones
New Patient
Unlisted Procedures Procedures
Uncertain behavior
30. 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.
Section 3 Index to External Causes of Injury (E codes)
Assault
Alphabetic Index (Volume 2)
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
31. Is the lateral lower arm bone (in line with the thumb).
Preferred Provider plan
Radius
Dirty claim
Undetermined
32. Forms the anterior part of the skull and the forehead
State License Number
Benign
Frontal Bone
Flat bones
33. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Advance Beneficiary Notice
Workers Compensation
Long bones
Surgical Package
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.
Fee Schedule
Group Insurance
Benign (hypertension)
Deductible
35. 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
Wheal
A plus sign (+)
Commercial Carriers
Established Patient
36. forms the roof of the nasal cavity.
Ulcermembranes
Retention of Medical Records
-26 - Professional Component
Ethmoid Bone
37. forms the two lower sides of the cranium.
The Universal Claim Form
Temporal Bone
Group Provider Number
Remittance Advice
38. 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
Reasons for Documentation
National Correct Coding Initiative (NCCI)
MEDICARE Part C
39. Are conditions - situations - and services not covered by the insurance carrier.
Chief complaint (CC)
Participating physician
Exclusions and Limitations
Review of Systems (ROS)
40. 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.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Health practitioner
Parietal Bones
Add-on codes
41. Deficient in pigment (melanin)
bullet (a
-32 - Mandated Services
Category II Codes CPT
Albino
42. 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.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Melanin
Contracted Rates with MCOs
Undetermined
43. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Evaluation and Management Review
Coding
Inpatient
Pre-paid Health Plan
44. Small collection of clear fluid;blister
Vesicle
History
appendicular skeleton .
History
45. This is a set of information the physician gathers from the patient regarding the following:
Maxilla
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
History
History of present illness (HPI)
46. Absence of hair from areas where it normally grows
History of present illness (HPI)
Nodule
Carpals
Alopecia
47. 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
Consultation
Pre-certification
Nodule
Accident
48. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.
Medical Records
Fissure
Spinal/Vertebral Column
HCPCS Level I codes
49. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
Ulcermembranes
-51 - Multiple Procedures
MEDICARE Part B
Occipital Bone
50. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Comminuted fracture
Suicide Attempt
-90 - Reference (Outside) Laboratory