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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. 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.
Gangrene
Melanin
Dirty claim
Fee Schedule
2. anterior to the temporal bones.
Point-of-Service plan (POS)
Category I Codes CPT
Health Maintenance Organization (HMO)
Sphenoid Bones
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
Pubic bone
Performing Provider Identification Number (PPIN)
Health Insurance Portability and Accountability Act (HIPAA)
Preferred Provider Organization (PPO)
4. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
nonessential modifiers
Zygoma
A plus sign (+)
Malignant
5. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
There are two types of sweat glands
Fiscal Intermediary
Benign (hypertension)
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
6. The main term in the index may by followed by terms within parenthesis.
Unique Provider Identification Number (UPIN)
Alphabetic Index (Volume 2)
Medicare Claim Status
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
7. 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
Participating physician
Chief complaint (CC)
Categorically needy -MEDICAID
The St. Anthony Relative Value for Physicians (RVP)
8. Represent changes in the text or definition between the triangles.
Lipocyte
Past - family and social history (PFSH)
Two triangular symbols (a
Secondary malignancy
9.
sprain
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
stand-alone codes
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
10. 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
Unlisted Procedures Procedures
Capitated Rates
Medical Records
MEDICARE Part D
11. 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
Subcategories
bullet (a
Sebaceous glands
Qualified diagnosis
12. 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:
Sphenoid Bones
Lipocyte
Hypertension Table
Medicaid
13. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Salter-Harris
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Medicare Claim Status
Lacrimal bones
14. This is not specified as benign or malignant in the diagnosis or medical record.
Salter-Harris
Radius
The Current Procedural Terminology (CPT)
Unspecified (hypertension)
15. Is the upper arm bone.
Humerus
Explanation of Benefits (EOB)
Medigap (Medicare Supplemental Insurance)
Coordination of Benefits (COB)
16. Produce secretions that allow the body to be moisturized or cooled.
Suicide Attempt
Retention of Medical Records
Secondary malignancy
sebaceous(oil) glands and the suddoriferous (sweat) glands
17. paired bones at the corner of each eye that cradle the tear ducts.
Advance Beneficiary Notice
Physician
Lacrimal bones
The Good Samaritan Act
18. 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)
Hairline
Advance Beneficiary Notice
Peer Review Organization (PRO)
19. 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.
Colles
Remittance Advice
sebaceous(oil) glands and the suddoriferous (sweat) glands
There are three layers to the skin
20. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Advance Beneficiary Notice
Electronic Claim
Vomer
History
21. Is an electronic or paper-based report of payment sent by the payer to the provider.
Reasons for Documentation
Subcategories
Relative Value Payment Schedules Method
Remittance Advice
22. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h
Colles
Commercial Carriers
Evaluation and Management Review
History of present illness (HPI)
23. 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)
Contracted Rates with MCOs
true ribs
Fraud
24. forms the two lower sides of the cranium.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Temporal Bone
Flat bones
Social Security Number
25. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Maxilla
Reasons for Documentation
Sections
Subcategories
26. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Full ROM
Abuse
The Universal Claim Form
Pre-certification
27. Pre-determined set of benefits covered under one set annual fee.
Malignant
Civil Monetary Penalties Law (CMPL)
Comminuted fracture
Pre-paid Health Plan
28. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Employee Liability
Gender rule
Employer Identification Number (EIN)
Polyp
29. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
There are two types of sweat glands
Employer Liability
Exclusions and Limitations
Occipital Bone
30. 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.
Disability insurance
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Ulcermembranes
Social Security Number
31. 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'.
Exclusions and Limitations
-51 - Multiple Procedures
Ethmoid Bone
Pre-authorization
32. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
MEDICAID COVERAGE
Point-of-Service plan (POS)
Fissure
Two triangular symbols (a
33. '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
Physician
False Claims Act (FCA)
sprain
Employee Liability
34. 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
Short bones
Fee Schedule
Vomer
Colles
35. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Non-covered benefit
Ischium
The Integumentary System
Peer Review Organization (PRO)
36. 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.
No ROM
Tabular List (Volume 1)...
Column 1/Column 2 (previously called Comprehensive/Component) Edits
False Claims Act (FCA)
37. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord
Maxilla
Occipital Bone
State License Number
Temporal Bone
38. 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.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
False ribs
National Correct Coding Initiative (NCCI)
False Claims Act (FCA)
39. forms the roof of the nasal cavity.
ulna
-32 - Mandated Services
Health Maintenance Organization (HMO)
Ethmoid Bone
40. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Participating physician
HCPCS Level I codes
Pre-certification
Patient Confidentiality
41. 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.
Evaluation and Management Review
Workers Compensation
Medicare
Preferred Provider plan
42. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Location Methods
There are two types of sweat glands
Zygoma
Assault
43. Consists of the skull - rib cage - and spine
axial skeleton
Unlisted Procedures Procedures
Humerus
Personal Insurance
44. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Zygoma
Evaluation and Management Review
-50 - Bilateral Procedure
Temporal Bone
45. 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
Add-on codes
Fee-for-Service
Coding
The St. Anthony Relative Value for Physicians (RVP)
46. The bone is broken and pierces an internal organ
Complicated
Column 1/Column 2 (previously called Comprehensive/Component) Edits
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
False ribs
47. 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
Capitated Rates
Consultation
Patient Confidentiality
Full ROM
48. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
Greenstick
Fiscal Intermediary
encounter form
Add-on codes
49. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Health practitioner
Spinal/Vertebral Column
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
sprain
50. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Retention of Medical Records
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Pathologic
Surgical Package
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