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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. 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.
Two triangular symbols (a
Sphenoid Bones
Dirty claim
Medical Records
2. 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
Contracted Rates with MCOs
Evaluation and Management Review
Outpatient
Spinal/Vertebral Column
3. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features
Accident
Medigap (Medicare Supplemental Insurance)
Electronic Claim
Sebaceous glands
4. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Vomer
Medically needy
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Pre-paid Health Plan
5. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Nodule
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Malignant
Performing Provider Identification Number (PPIN)
6. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Melanin
Malignant
Workers Compensation
Performing Provider Identification Number (PPIN)
7. paired bones at the corner of each eye that cradle the tear ducts.
Lacrimal bones
sprain
Undetermined
essential modifiers
8. A fat cell
Retention of Medical Records
Carpals
Occipital Bone
Lipocyte
9. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.
Uncertain behavior
False Claims Act (FCA)
Patient Confidentiality
Advance Beneficiary Notice
10. This is the inventory of the constitutional symptoms regarding the various body systems.
Review of Systems (ROS)
Benign (hypertension)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
encounter form
11. 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
HCPCS Level II codes (National Codes)
Coding
MEDICARE Part A
Commercial Carriers
12. 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
Two triangular symbols (a
Impetigo
Unauthorized benefit
13. Represent changes in the text or definition between the triangles.
Two triangular symbols (a
Evaluation and Management Review
Pubic bone
Secondary malignancy
14. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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15. The fractured area of bone collapses on itself.
Medicaid
premium
MEDICARE Part D
Compression fracture
16. 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
Clearinghouse
The St. Anthony Relative Value for Physicians (RVP)
Multigravida
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
17. 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.
Paper Claim
Medical Records
Impetigo
Pubic bone
18. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u
upper appendicular skeleton
Hypertension Table
ulna
Indemnity Insurance
19. The moon like white area at the base of the nail.
Humerus
lunula
Medicare
Two triangular symbols (a
20. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.
Radius
Invalid claim
Preferred Provider plan
Surgical Package
21. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.
The St. Anthony Relative Value for Physicians (RVP)
premium
Category III Codes CPT
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
22. 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.
Personal Insurance
Malignant
ligaments
Medicaid
23. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Pre-certification
Chief complaint
Rejected claim
MEDICARE Part B
24. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance
Disability insurance
Eligibility
Impetigo
Melanin
25. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Health Insurance Portability and Accountability Act (HIPAA)
The Current Procedural Terminology (CPT)
Consultation
Full ROM
26. forms the two lower sides of the cranium.
Group Provider Number
appendicular skeleton .
Temporal Bone
There are three layers to the skin
27. 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
Sub classification
Keratin
Preferred Provider Organization (PPO)
28. 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
Column 1/Column 2 (previously called Comprehensive/Component) Edits
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
HCPCS Level II codes (National Codes)
29. The moon like white area at the base of the nail.
circle with a line through it)
Melanin
lunula
Ischium
30. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Indemnity Insurance
Melanin
Categories
TRICARE PLANS
31. The main term in the index may by followed by terms within parenthesis.
Sesamoid bones
Point-of-Service plan (POS)
Social Security Number
Alphabetic Index (Volume 2)
32. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
stand-alone codes
Medicare
Suicide Attempt
Benign (hypertension)
33. 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 (hypertension)
Short bones
TRICARE
MEDICARE Part C
34. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Exclusions and Limitations
Pre-paid Health Plan
Outpatient
Carpals
35. numbers 8-10 - are attached to the sternum by cartilage
Inpatient
Health Maintenance Organization (HMO)
National Correct Coding Initiative (NCCI)
False ribs
36. 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
Employer Identification Number (EIN)
Remittance Advice
Preferred Provider plan
37. The bone is broken and pierces an internal organ
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Short bones
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Complicated
38. Deficient in pigment (melanin)
Frontal Bone
Albino
National Correct Coding Initiative (NCCI)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
39. 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
Long bones
False Claims Act (FCA)
State License Number
Fee-for-Service
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.
-32 - Mandated Services
Add-on codes
stand-alone codes
-50 - Bilateral Procedure
41. 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
-99 - Multiple Modifiers
Deductible
Abuse
Lacrimal bones
42. The bone is broken and pierces an internal organ
Medically needy
Established Patient
Complicated
Category III Codes CPT
43. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Sub classification
National Correct Coding Initiative (NCCI)
Subcategories
Short bones
44. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.
Sesamoid bones
Sections
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
-26 - Professional Component
45. This modifier is used when the same procedure is performed on a mirror-image part of the body..
-50 - Bilateral Procedure
Section 3 Index to External Causes of Injury (E codes)
History of present illness (HPI)
itemized statement
46. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Medicaid
Tabular List (Volume 1)...
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Category I Codes CPT
47. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Established Patient
-32 - Mandated Services
Qualified diagnosis
Personal Insurance
48. 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.
Employee Liability
Clean claim
phalanges (phalanx.s)
Pathologic
49. 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
CPT SECTIONS.
Birthday rule
The Integumentary System
Sections
50. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
-50 - Bilateral Procedure
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Peer Review Organization (PRO)
Social Security Number
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