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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. 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
essential modifiers
TRICARE
Dirty claim
Sub classification
2. 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
Radius
Capitated Rates
Rib Cage
Commercial Carriers
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.
Ethmoid Bone
Spinal/Vertebral Column
Mutually Exclusive Edits
Dirty claim
4. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Category III Codes CPT
Unauthorized benefit
circle with a line through it)
5. 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
Preferred Provider Organization (PPO)
The Integumentary System
Birthday rule
Patient Confidentiality
6. Pre-determined set of benefits covered under one set annual fee.
Pre-paid Health Plan
Categorically needy -MEDICAID
Categories
Health Insurance Portability and Accountability Act (HIPAA)
7. 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
Benign (hypertension)
Blue Cross/Blue Shield Plans
Neoplasm Table
Reasons for Documentation
8. Noninvasive - non-spreading - nonmalignant
CPT SECTIONS.
Benign
The St. Anthony Relative Value for Physicians (RVP)
Mutually Exclusive Edits
9. requires investigation and needs further clarification.
Blue Cross/Blue Shield Plans
Colles
Dirty claim
Rejected claim
10. The reason the patient came to see the physician.
Carpals
Chief complaint (CC)
Established patient
No ROM
11. Represent changes in the text or definition between the triangles.
Eligibility
Two triangular symbols (a
Mandible
Add-on codes
12. This is a set of information the physician gathers from the patient regarding the following:
Point-of-Service plan (POS)
Lipocyte
History
Unauthorized benefit
13. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
co-payment
Accept assignment
Chief complaint
Full ROM
14. 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.
Hypertension Table
Non-covered benefit
Sub classification
Health Maintenance Organization (HMO)
15. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
axial skeleton
-32 - Mandated Services
HCPCS Level II codes (National Codes)
The St. Anthony Relative Value for Physicians (RVP)
16. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Nonparticipating physician
Nodule
-90 - Reference (Outside) Laboratory
Medically needy
17. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Alphabetic Index (Volume 2)
Secondary malignancy
Fraud
National Correct Coding Initiative (NCCI)
18. The lower anterior part of the bone
encounter form
Liability insurance
Pubic bone
Melanin
19. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Undetermined
Alphabetic Index (Volume 2)
The Patient Care Partnership (Patient's Bill of Rights)
20. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Health Maintenance Organization (HMO)
New Patient
Keratin
21. 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.
Add-on codes
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Modifiers
Temporal Bone
22. A fat cell
HCPCS Level I codes
Lipocyte
Medical necessity
Health practitioner
23. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
Health Insurance Portability and Accountability Act (HIPAA)
encounter form
axial skeleton
Relative Value Payment Schedules Method
24.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
MEDICARE Part C
Dirty claim
phalanges (phalanx.s)
25. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
A plus sign (+)
Limited ROM
History of present illness (HPI)
CPT SECTIONS.
26. Are conditions - situations - and services not covered by the insurance carrier.
Review of Systems (ROS)
Sebaceous glands
Exclusions and Limitations
MEDICARE Part C
27. 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.
Medical necessity
Category III Codes CPT
triangle (a
The Good Samaritan Act
28. poisoning was inflicted by another person with intent to kill or injure
-99 - Multiple Modifiers
Alphabetic Index (Volume 2)
Assault
Advance Beneficiary Notice
29. 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 -
Impacted
Inpatient
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
essential modifiers
30. 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).
itemized statement
Humerus
Sections
Benign (hypertension)
31. 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
Musculoskeletal System
Coinsurance
sebaceous(oil) glands and the suddoriferous (sweat) glands
Health Maintenance Organization (HMO)
32. This modifier is used when the same procedure is performed on a mirror-image part of the body..
-50 - Bilateral Procedure
Eligibility
The Patient Care Partnership (Patient's Bill of Rights)
MEDICARE Part B
33. 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
MEDICARE Part B
New Patient
Gangrene
Unique Provider Identification Number (UPIN)
34. anterior to the temporal bones.
Sphenoid Bones
Unspecified nature
Social Security Number
Category III Codes CPT
35. 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.
Coinsurance
Colles
-90 - Reference (Outside) Laboratory
encounter form
36. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Coding
Employee Liability
Primary malignancy
essential modifiers
37. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Pre-authorization
Humerus
Coordination of Benefits (COB)
38. Represents a new procedure or service code added since the previous edition of the manual.
bullet (a
Advance Beneficiary Notice
Pubic bone
Abuse
39. 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:
Medicare Claim Status
Unspecified (hypertension)
Hypertension Table
-50 - Bilateral Procedure
40. 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
Point-of-Service plan (POS)
A plus sign (+)
MEDICAID COVERAGE
ligaments
41. 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
Blue Cross/Blue Shield Plans
Gender rule
Category II Codes CPT
-51 - Multiple Procedures
42. 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
Paper Claim
Mutually Exclusive Edits
Ethmoid Bone
Carpals
43. 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
Exclusions and Limitations
true ribs
CPT SECTIONS.
Rejected claim
44. Deficient in pigment (melanin)
Albino
Sub classification
appendicular skeleton .
False ribs
45. 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
Sebaceous glands
Relative Value Payment Schedules Method
Surgical Package
Participating physician
46. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Group practice
Unspecified nature
Preferred Provider Organization (PPO)
Vesicle
47. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
itemized statement
Malignant
Unauthorized benefit
true ribs
48. Poisoning cannot be determined whether intentional or accidental.
Unlisted Procedures Procedures
Undetermined
New Patient
Medical Records
49. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
There are three layers to the skin
Established Patient
Peer Review Organization (PRO)
Unspecified nature
50. male of household is primary payer
No ROM
Vesicle
Malignant
Gender rule
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