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Medical Billing And Coding Vocab
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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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. is defined as one who has not received any medical services within the last three years.
Surgical Package
New Patient
co-payment
Parietal Bones
2. 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'.
Lipocyte
Pre-authorization
Albino
Personal Insurance
3. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
Clean claim
Chief complaint
Non-covered benefit
Preferred Provider plan
4. Benign growth extending from the surface of the mucous membrane
Polyp
Macule
Secondary malignancy
Limited ROM
5. 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.
The St. Anthony Relative Value for Physicians (RVP)
Dirty claim
Group practice
Group Provider Number
6. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari
Employer Identification Number (EIN)
Melanin
Benign (hypertension)
Categorically needy -MEDICAID
7. The physician must obtain this number in order to practice within a state.
Reasons for Documentation
State License Number
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Peer Review Organization (PRO)
8. 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
Abuse
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Review of Systems (ROS)
Ulcermembranes
9. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Tabular List (Volume 1)...
Neoplasm Table
Medicaid
Group Insurance
10. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Group practice
Long bones
Chief complaint (CC)
National Correct Coding Initiative (NCCI)
11. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Civil Monetary Penalties Law (CMPL)
Employer Identification Number (EIN)
Greenstick
premium
12. Is the lower medial arm bone.
ulna
sprain
Pelvis
Participating physician
13. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Accept assignment
Rib Cage
Fee-for-Service
False Claims Act (FCA)
14. Is the lower medial arm bone.
ulna
Vesicle
upper appendicular skeleton
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
15. Pre-determined set of benefits covered under one set annual fee.
Accident
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Compression fracture
Pre-paid Health Plan
16. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
False Claims Act (FCA)
Unspecified (hypertension)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Performing Provider Identification Number (PPIN)
17. 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
Civil Monetary Penalties Law (CMPL)
Secondary malignancy
Coding
MEDICAID COVERAGE
18. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Greenstick
Rib Cage
Gender rule
Sphenoid Bones
19. Number assigned to the physician by Medicare program.
Chapters
Mutually Exclusive Edits
Unique Provider Identification Number (UPIN)
phalanges (phalanx.s)
20. A pregnant woman who has had at least one previous pregnancy.
Unspecified nature
Multigravida
ligaments
Coding
21. 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.
Temporal Bone
nonessential modifiers
Sections
circle with a line through it)
22. 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.
Group practice
Medical Records
Undetermined
Paper Claim
23. Typically not used on the claim form unless the provider does not have an EIN.
Social Security Number
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Unspecified (hypertension)
Temporal Bone
24. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Spinal/Vertebral Column
premium
Hairline
History of present illness (HPI)
25. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:
Short bones
Established Patient
premium
Hypertension Table
26. Numbers 1-7 - attach directly to the sternum in the front of the body.
Fraud
New Patient
true ribs
bullet (a
27. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Musculoskeletal System
Compliance Regulations
Accept assignment
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
28. 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.
Sesamoid bones
Alopecia
Collagen
Advance Beneficiary Notice
29. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.
Benign
Category III Codes CPT
Compression fracture
Contracted Rates with MCOs
30. 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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31. 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
Gangrene
Performing Provider Identification Number (PPIN)
Rejected claim
32. 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
Medigap (Medicare Supplemental Insurance)
-90 - Reference (Outside) Laboratory
Ischium
33. 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.
Hairline
Birthday rule
Uncertain behavior
National Correct Coding Initiative (NCCI)
34. The moon like white area at the base of the nail.
Malignant
MEDICARE Part A
lunula
nonessential modifiers
35. 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
Workers Compensation
The Current Procedural Terminology (CPT)
National Correct Coding Initiative (NCCI)
Relative Value Payment Schedules Method
36. 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.
Carcinoma (Ca) in situ
Medical Records
Relative Value Payment Schedules Method
Suicide Attempt
37. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
Sebaceous glands
Health Care Financing Administration Common Procedure Coding System
Radius
Sections
38. 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
Medicare Claim Status
Medical necessity
Impacted
39. 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.
Uncertain behavior
Retention of Medical Records
Physician
CPT SECTIONS.
40. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Vomer
Secondary malignancy
Consultation
Surgical Package
41. 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
Limited ROM
Suicide Attempt
Blue Cross/Blue Shield Plans
Performing Provider Identification Number (PPIN)
42. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Blue Cross/Blue Shield Plans
State License Number
Greenstick
Personal Insurance
43. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
National Correct Coding Initiative (NCCI)
Established patient
Outpatient
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
44. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Malignant
CPT SECTIONS.
Alopecia
Unique Provider Identification Number (UPIN)
45. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
History of present illness (HPI)
TRICARE
Capitated Rates
Physician
46. 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
Health Insurance Portability and Accountability Act (HIPAA)
Category I Codes CPT
Unspecified (hypertension)
Fee-for-Service
47. 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
Physician
Disability insurance
Categorically needy -MEDICAID
CPT SECTIONS.
48. Consists of the skull - rib cage - and spine
Dirty claim
axial skeleton
Relative Value Payment Schedules Method
Invalid claim
49. Pre-determined set of benefits covered under one set annual fee.
Secondary malignancy
False Claims Act (FCA)
Pre-paid Health Plan
Frontal Bone
50. 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.
Explanation of Benefits (EOB)
-26 - Professional Component
Add-on codes
Two triangular symbols (a
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