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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. Law passed by the federal government to prosecute cases of Medicaid fraud.
False Claims Act (FCA)
upper appendicular skeleton
Review of Systems (ROS)
Civil Monetary Penalties Law (CMPL)
2. major skin pigment
Clean claim
Category I Codes CPT
Long bones
Melanin
3. 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
ligaments
Non-covered benefit
Outpatient
The Integumentary System
4. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Medical necessity
Suicide Attempt
Vomer
Long bones
5. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Deductible
Medicaid
The Patient Care Partnership (Patient's Bill of Rights)
TRICARE PLANS
6. are small with irregular shapes. They are found in the wrist and ankle.
Short bones
Tabular List (Volume 1)...
The Integumentary System
Birthday rule
7. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fiscal Intermediary
No ROM
itemized statement
National Correct Coding Initiative (NCCI)
8. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Health practitioner
HCPCS Level I codes
-90 - Reference (Outside) Laboratory
Unspecified nature
9. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
upper appendicular skeleton
encounter form
Palatine bones
Chapters
10. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Coordination of Benefits (COB)
Accident
History of present illness (HPI)
axial skeleton
11. major skin pigment
Chief complaint (CC)
Capitated Rates
-99 - Multiple Modifiers
Melanin
12. 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.
Preferred Provider Organization (PPO)
Non-covered benefit
Outpatient
Temporal Bone
13. Produce secretions that allow the body to be moisturized or cooled.
Surgical Package
Occipital Bone
sebaceous(oil) glands and the suddoriferous (sweat) glands
History
14. 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.
Personal Insurance
Patient Confidentiality
Group practice
Accept assignment
15. 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'.
There are two types of sweat glands
Pre-authorization
Malignant
Category I Codes CPT
16. Superior and widest bone
Pelvis
stand-alone codes
Accept assignment
Vomer
17. is a traumatic injury to a joint involving the soft tissue.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
sprain
Outpatient
National Correct Coding Initiative (NCCI)
18. 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
Maxilla
Patient Confidentiality
Carcinoma (Ca) in situ
Preferred Provider Organization (PPO)
19. 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.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Limited ROM
Ischium
Section 3 Index to External Causes of Injury (E codes)
20. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Medicare
Chapters
Multigravida
Category I Codes CPT
21. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Qualified diagnosis
Accept assignment
Musculoskeletal System
22. 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
Musculoskeletal System
Health Maintenance Organization (HMO)
-51 - Multiple Procedures
Albino
23. is a traumatic injury to a joint involving the soft tissue.
sprain
Mutually Exclusive Edits
Complicated
Pre-authorization
24. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
premium
Pre-certification
State License Number
itemized statement
25. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.
The Patient Care Partnership (Patient's Bill of Rights)
essential modifiers
Employer Identification Number (EIN)
Group Provider Number
26. uncertain whether benign or malignant; borderline malignancy
Keratin
Uncertain behavior
phalanges (phalanx.s)
Chief complaint (CC)
27. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
False ribs
premium
-51 - Multiple Procedures
Group Insurance
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
Carcinoma (Ca) in situ
-99 - Multiple Modifiers
Nonparticipating physician
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
29. 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
ligaments
Compliance Regulations
Unspecified nature
Employer Liability
30. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Categorically needy -MEDICAID
Short bones
Rib Cage
Section 3 Index to External Causes of Injury (E codes)
31. Is a working diagnosis which is not yet established.
Qualified diagnosis
triangle (a
Pre-certification
sebaceous(oil) glands and the suddoriferous (sweat) glands
32. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
HCPCS Level II codes (National Codes)
Coding
-90 - Reference (Outside) Laboratory
true ribs
33. the bone is crushed and or shattered.
true ribs
Point-of-Service plan (POS)
Comminuted fracture
Primary malignancy
34. forms the two lower sides of the cranium.
Sections
Flat bones
Temporal Bone
circle with a line through it)
35. 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
Group Insurance
Commercial Carriers
Established patient
New patient
36. uncertain whether benign or malignant; borderline malignancy
Humerus
Fiscal Intermediary
MEDICARE Part C
Uncertain behavior
37. most synarthroses are immovable joints held together by fibrous tissue.
circle with a line through it)
Rejected claim
No ROM
MEDICARE Part A
38. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Employee Liability
Fraud
Sesamoid bones
Musculoskeletal System
39. represents Exemption from the use of modifier -51
Wheal
Disability insurance
New Patient
circle with a line through it)
40. 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
Capitated Rates
CPT SECTIONS.
Peer Review Organization (PRO)
HCPCS Level II codes (National Codes)
41. Numbers 1-7 - attach directly to the sternum in the front of the body.
Review of Systems (ROS)
Vesicle
true ribs
Fee Schedule
42. 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.
Medical Records
TRICARE
Subcategories
False Claims Act (FCA)
43. male of household is primary payer
Gender rule
Electronic Claim
False Claims Act (FCA)
lunula
44. 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.
HCPCS Level II codes (National Codes)
Dirty claim
Eligibility
Accept assignment
45. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Suicide Attempt
Hairline
triangle (a
Gender rule
46. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Medigap (Medicare Supplemental Insurance)
bullet (a
Coordination of Benefits (COB)
There are two types of sweat glands
47. Are composed of three-digit codes representing a single disease or condition.
Preferred Provider Organization (PPO)
The Good Samaritan Act
Advance Beneficiary Notice
Categories
48. Is one who has no contract with the health insurance plan.
Nonparticipating physician
Health Maintenance Organization (HMO)
Tabular List (Volume 1)...
Suicide Attempt
49. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
There are two types of sweat glands
The Good Samaritan Act
Suicide Attempt
Flat bones
50. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
co-payment
Employer Liability
Hairline
MEDICARE Part D
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