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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. 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
False ribs
Greenstick
Chief complaint
2. The physician must obtain this number in order to practice within a state.
Categories
Spinal/Vertebral Column
State License Number
Category III Codes CPT
3. 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
State License Number
Group Insurance
Preferred Provider Organization (PPO)
TRICARE PLANS
4. Consists of the skull - rib cage - and spine
TRICARE
stand-alone codes
axial skeleton
Inpatient
5. The poisoning was self-inflicted.
Hypertension Table
Fiscal Intermediary
Sebaceous glands
Suicide Attempt
6. 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
Review of Systems (ROS)
Unique Provider Identification Number (UPIN)
Retention of Medical Records
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
7. Forms the sides of the cranium
Peer Review Organization (PRO)
triangle (a
Parietal Bones
Complicated
8. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Subcategories
Polyp
There are two types of sweat glands
Pre-authorization
9. 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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10. 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
Health Care Financing Administration Common Procedure Coding System
State License Number
Salter-Harris
11. Are conditions - situations - and services not covered by the insurance carrier.
Macule
Exclusions and Limitations
Malignant
Two triangular symbols (a
12. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual
Fee Schedule
Qualified diagnosis
Uncertain behavior
Employee Liability
13. 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
Polyp
-51 - Multiple Procedures
Preferred Provider plan
Group Provider Number
14. is a traumatic injury to a joint involving the soft tissue.
sprain
Review of Systems (ROS)
False ribs
Retention of Medical Records
15. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Abuse
Patient Confidentiality
Electronic Claim
16. 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.
-26 - Professional Component
Limited ROM
MEDICAID COVERAGE
Fiscal Intermediary
17. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
TRICARE
bullet (a
Vomer
18. 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 -
Qualified diagnosis
-90 - Reference (Outside) Laboratory
Gender rule
essential modifiers
19. 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
Non-covered benefit
Vesicle
Health Maintenance Organization (HMO)
Fissure
20. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Fraud
Modifiers
Mutually Exclusive Edits
21.
Patient Confidentiality
Tabular List (Volume 1)...
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Dirty claim
22. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.
Peer Review Organization (PRO)
appendicular skeleton .
False Claims Act (FCA)
Sub classification
23. 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
Health Care Financing Administration Common Procedure Coding System
Sebaceous glands
Remittance Advice
Pre-certification
24. 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.
Sub classification
Retention of Medical Records
Health practitioner
Carpals
25. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Explanation of Benefits (EOB)
-90 - Reference (Outside) Laboratory
Medicare
Rib Cage
26. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Radius
Abuse
Accept assignment
-90 - Reference (Outside) Laboratory
27. 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
Workers Compensation
lunula
Compression fracture
National Correct Coding Initiative (NCCI)
28. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
nonessential modifiers
Complicated
Long bones
Lacrimal bones
29. 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.
Performing Provider Identification Number (PPIN)
Medicare Claim Status
true ribs
Evaluation and Management Review
30. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
MEDICAID COVERAGE
Fissure
encounter form
History of present illness (HPI)
31. 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 -
Explanation of Benefits (EOB)
Inferior nasal conchae
Vomer
Indemnity Insurance
32. Represents a new procedure or service code added since the previous edition of the manual.
bullet (a
Section 3 Index to External Causes of Injury (E codes)
Benign
Medicare Claim Status
33. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Contracted Rates with MCOs
State License Number
Eligibility
Medical necessity
34. Any fracture occurring spontaneously as a result of disease.
Pathologic
Unlisted Procedures Procedures
Carpals
Non-covered benefit
35. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
circle with a line through it)
Social Security Number
Humerus
Tabular List (Volume 1)...
36. 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
National Correct Coding Initiative (NCCI)
Section 3 Index to External Causes of Injury (E codes)
Multigravida
Health Maintenance Organization (HMO)
37. Mild or controlled hypertension and no damage to the vascular system or organs.
Benign (hypertension)
Compliance Regulations
ligaments
Physician
38. Pre-determined set of benefits covered under one set annual fee.
Pre-paid Health Plan
Pubic bone
Location Methods
Tabular List (Volume 1)...
39. 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
Commercial Carriers
nonessential modifiers
Liability insurance
The Current Procedural Terminology (CPT)
40. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
nonessential modifiers
Clean claim
MEDICAID COVERAGE
41. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Impacted
Secondary malignancy
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Medigap (Medicare Supplemental Insurance)
42. 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.
Chief complaint (CC)
Medical Records
MEDICARE Part A
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
43. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
nonessential modifiers
ulna
Medical Records
Keratin
44. This is not specified as benign or malignant in the diagnosis or medical record.
Compression fracture
Unspecified (hypertension)
Subcategories
New patient
45. 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
Coordination of Benefits (COB)
stand-alone codes
Workers Compensation
Point-of-Service plan (POS)
46. 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
essential modifiers
-51 - Multiple Procedures
Civil Monetary Penalties Law (CMPL)
ligaments
47. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Clearinghouse
Lacrimal bones
Category I Codes CPT
Add-on codes
48. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Hypertension Table
Comminuted fracture
Abuse
Secondary malignancy
49. '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
nonessential modifiers
Sub classification
Employee Liability
Vomer
50. Upper jaw bone
Medical Records
Health Insurance Portability and Accountability Act (HIPAA)
Group Insurance
Maxilla
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