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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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1. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
co-payment
Advance Beneficiary Notice
Established Patient
History of present illness (HPI)
2. This is the inventory of the constitutional symptoms regarding the various body systems.
TRICARE
Review of Systems (ROS)
Lacrimal bones
-26 - Professional Component
3. Consists of the skull - rib cage - and spine
upper appendicular skeleton
Clearinghouse
Assault
axial skeleton
4. Most billing-related cases are based on HIPAA and False Claims Act.
Full ROM
Liability insurance
Compliance Regulations
nonessential modifiers
5. This is the inventory of the constitutional symptoms regarding the various body systems.
upper appendicular skeleton
Review of Systems (ROS)
Group practice
Categories
6. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Short bones
Coordination of Benefits (COB)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Civil Monetary Penalties Law (CMPL)
7. 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
Preferred Provider plan
axial skeleton
Commercial Carriers
Blue Cross/Blue Shield Plans
8. The reason the patient came to see the physician.
Rejected claim
Disability insurance
Chief complaint (CC)
Category II Codes CPT
9. 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).
-90 - Reference (Outside) Laboratory
Sesamoid bones
Sections
Medicaid
10. Represent changes in the text or definition between the triangles.
Categorically needy -MEDICAID
Peer Review Organization (PRO)
Two triangular symbols (a
Qualified diagnosis
11. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Fee-for-Service
Wheal
Gender rule
Clean claim
12. is a traumatic injury to a joint involving the soft tissue.
sprain
Civil Monetary Penalties Law (CMPL)
TRICARE PLANS
Ischium
13. 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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14. Describes the services billed and includes a breakdown of how the payment is determined
Inferior nasal conchae
Explanation of Benefits (EOB)
Unlisted Procedures Procedures
Clean claim
15. 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.
encounter form
appendicular skeleton .
History
Physician
16. Number assigned by the insurance company to a physician who renders services to patients.
Inpatient
Ethmoid Bone
Ischium
Provider Identification Number (PIN)
17. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Established patient
Location Methods
Employee Liability
New patient
18. 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
Unspecified nature
There are three layers to the skin
TRICARE
Coinsurance
19. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Group Provider Number
Subcategories
Carcinoma (Ca) in situ
20. Groove or crack like sore
Sub classification
Add-on codes
Fissure
Paper Claim
21. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Secondary malignancy
HCPCS Level I codes
sebaceous(oil) glands and the suddoriferous (sweat) glands
The Good Samaritan Act
22. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran
Rejected claim
Exclusions and Limitations
Clearinghouse
Category III Codes CPT
23. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Fee Schedule
Fiscal Intermediary
true ribs
24. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Chief complaint (CC)
A plus sign (+)
-26 - Professional Component
25. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
HCPCS Level I codes
Nodule
Health practitioner
phalanges (phalanx.s)
26. Absence of hair from areas where it normally grows
Alopecia
Categorically needy -MEDICAID
-32 - Mandated Services
Pre-paid Health Plan
27. Forms the anterior part of the skull and the forehead
Parietal Bones
Dirty claim
Rejected claim
Frontal Bone
28. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers
The Integumentary System
-99 - Multiple Modifiers
true ribs
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
29. 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
Disability insurance
Salter-Harris
Categories
HCPCS Level II codes (National Codes)
30. 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
The St. Anthony Relative Value for Physicians (RVP)
Civil Monetary Penalties Law (CMPL)
Radius
Blue Cross/Blue Shield Plans
31. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Fiscal Intermediary
HCPCS Level II codes (National Codes)
Accept assignment
32.
Lacrimal bones
Sebaceous glands
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Coding
33. is defined as one who has not received any medical services within the last three years.
Fraud
-32 - Mandated Services
Reasons for Documentation
New Patient
34. Most billing-related cases are based on HIPAA and False Claims Act.
History
Established patient
Compliance Regulations
New patient
35. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which
Colles
Modifiers
Review of Systems (ROS)
Employer Liability
36. Are composed of three-digit codes representing a single disease or condition.
Categorically needy -MEDICAID
Ischium
lunula
Categories
37. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Parietal Bones
Fraud
Commercial Carriers
38. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Ulcermembranes
MEDICARE Part A
Limited ROM
Performing Provider Identification Number (PPIN)
39. Is a working diagnosis which is not yet established.
Explanation of Benefits (EOB)
Qualified diagnosis
-99 - Multiple Modifiers
Peer Review Organization (PRO)
40. Describes the services billed and includes a breakdown of how the payment is determined
Patient Confidentiality
History of present illness (HPI)
Pathologic
Explanation of Benefits (EOB)
41. 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
Coinsurance
CPT SECTIONS.
circle with a line through it)
premium
42. 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).
Collagen
Employer Identification Number (EIN)
Chapters
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
43. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
-26 - Professional Component
Palatine bones
44. 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)
HCPCS Level I codes
Medicare
Preferred Provider plan
45. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
The Integumentary System
true ribs
Workers Compensation
Musculoskeletal System
46. 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
Invalid claim
The Integumentary System
Social Security Number
47. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Location Methods
sebaceous(oil) glands and the suddoriferous (sweat) glands
No ROM
ligaments
48. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.
Consultation
Review of Systems (ROS)
Group practice
Birthday rule
49. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Nodule
Nodule
Preferred Provider plan
Carcinoma (Ca) in situ
50. 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
Pubic bone
The St. Anthony Relative Value for Physicians (RVP)
Pelvis
Accident
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