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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. Structural protein found in the skin and connective tissue
Collagen
Workers Compensation
Coding
Category I Codes CPT
2. 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
Category I Codes CPT
Malignant
Paper Claim
stand-alone codes
3. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
-99 - Multiple Modifiers
Accident
Preferred Provider Organization (PPO)
MEDICARE Part B
4. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
Group Insurance
-99 - Multiple Modifiers
There are three layers to the skin
New Patient
5. The moon like white area at the base of the nail.
Categories
The Integumentary System
lunula
Explanation of Benefits (EOB)
6. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Past - family and social history (PFSH)
Advance Beneficiary Notice
Medicaid
Employer Identification Number (EIN)
7. Are conditions - situations - and services not covered by the insurance carrier.
Exclusions and Limitations
Clearinghouse
Contracted Rates with MCOs
Inpatient
8. most synarthroses are immovable joints held together by fibrous tissue.
No ROM
Physician
CPT SECTIONS.
Past - family and social history (PFSH)
9. 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.
Clean claim
Macule
Section 3 Index to External Causes of Injury (E codes)
Sesamoid bones
10. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
Medicare Claim Status
Health Insurance Portability and Accountability Act (HIPAA)
HCPCS Level I codes
Inferior nasal conchae
11. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Coinsurance
-51 - Multiple Procedures
Employer Liability
Collagen
12. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Medically needy
Peer Review Organization (PRO)
-50 - Bilateral Procedure
Albino
13. Consists of the skull - rib cage - and spine
axial skeleton
Categories
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Explanation of Benefits (EOB)
14. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Sesamoid bones
Humerus
Full ROM
Categorically needy -MEDICAID
15.
Medicare
ulna
Section 3 Index to External Causes of Injury (E codes)
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
16. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
The Current Procedural Terminology (CPT)
Flat bones
premium
Ischium
17. 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).
Unauthorized benefit
Sections
Ethmoid Bone
Group practice
18. 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
Medicaid
Accident
ulna
upper appendicular skeleton
19. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Surgical Package
Health Insurance Portability and Accountability Act (HIPAA)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Disability insurance
20. 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..
Musculoskeletal System
Compression fracture
Medicare
Gangrene
21. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Flat bones
Fiscal Intermediary
Assault
22. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Unique Provider Identification Number (UPIN)
Coinsurance
Impetigo
Ethmoid Bone
23. 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.
Limited ROM
Zygoma
Pre-certification
Preferred Provider plan
24. 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.
bullet (a
Lipocyte
Advance Beneficiary Notice
MEDICARE Part C
25. Is the lateral lower arm bone (in line with the thumb).
Birthday rule
Employer Liability
Radius
Past - family and social history (PFSH)
26. 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
Medicare
Categorically needy -MEDICAID
Sesamoid bones
ligaments
27. 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
Sections
Maxilla
Impacted
stand-alone codes
28. uncertain whether benign or malignant; borderline malignancy
-99 - Multiple Modifiers
Commercial Carriers
Uncertain behavior
Participating physician
29. Indicates add-on codes
A plus sign (+)
lunula
essential modifiers
Reasons for Documentation
30. 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
Occipital Bone
Malignant
The Good Samaritan Act
Section 3 Index to External Causes of Injury (E codes)
31. 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).
nonessential modifiers
Fraud
Sections
Preferred Provider Organization (PPO)
32. 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
Column 1/Column 2 (previously called Comprehensive/Component) Edits
There are three layers to the skin
TRICARE PLANS
Alphabetic Index (Volume 2)
33. 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.
Salter-Harris
Medicaid
axial skeleton
Polyp
34. Is the qualifying factor or factors that must be met before a patient receives benefits.
Suicide Attempt
Ischium
Ischium
Eligibility
35. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
triangle (a
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Clearinghouse
Malignant
36. Law passed by the federal government to prosecute cases of Medicaid fraud.
Evaluation and Management Review
There are two types of sweat glands
Civil Monetary Penalties Law (CMPL)
Categories
37. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
sebaceous(oil) glands and the suddoriferous (sweat) glands
MEDICARE Part B
Carcinoma (Ca) in situ
There are two types of sweat glands
38. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s
Remittance Advice
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Consultation
39. 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
Category III Codes CPT
Patient Confidentiality
Unauthorized benefit
Personal Insurance
40. paired bones at the corner of each eye that cradle the tear ducts.
Temporal Bone
Lacrimal bones
MEDICAID COVERAGE
Provider Identification Number (PIN)
41. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
False Claims Act (FCA)
-32 - Mandated Services
Eligibility
Medical necessity
42. 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
appendicular skeleton .
Parietal Bones
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Greenstick
43. make up part of the roof of the mouth
Wheal
Preferred Provider Organization (PPO)
False ribs
Palatine bones
44. 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
HCPCS Level I codes
Melanin
Pubic bone
Reasons for Documentation
45. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
Vomer
Chapters
Mutually Exclusive Edits
Spinal/Vertebral Column
46. 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)
Health Insurance Portability and Accountability Act (HIPAA)
Capitated Rates
There are two types of sweat glands
47. 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
Eligibility
Vomer
Paper Claim
Health Maintenance Organization (HMO)
48. make up part of the roof of the mouth
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Macule
Disability insurance
Palatine bones
49. 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
Health Care Financing Administration Common Procedure Coding System
stand-alone codes
lunula
Employer Liability
50. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Peer Review Organization (PRO)
Advance Beneficiary Notice
Relative Value Payment Schedules Method
The Good Samaritan Act
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