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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.
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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. 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
Hairline
-90 - Reference (Outside) Laboratory
Carpals
MEDICARE Part D
2. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Provider Identification Number (PIN)
Secondary malignancy
MEDICARE Part A
Medigap (Medicare Supplemental Insurance)
3. 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
Capitated Rates
Fraud
Fee Schedule
CPT SECTIONS.
4. 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
Hairline
TRICARE PLANS
Coordination of Benefits (COB)
MEDICARE Part D
5.
Evaluation and Management Review
Category I Codes CPT
New patient
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
6. 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
Coding
Sebaceous glands
Subcategories
triangle (a
7. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.
Clearinghouse
Patient Confidentiality
Unauthorized benefit
Hairline
8. Indicates add-on codes
History of present illness (HPI)
Medicare
A plus sign (+)
Medically needy
9. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Consultation
Commercial Carriers
Melanin
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
10. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
phalanges (phalanx.s)
Health Maintenance Organization (HMO)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Pubic bone
11. Number assigned to the physician by Medicare program.
co-payment
Compression fracture
Unique Provider Identification Number (UPIN)
Fiscal Intermediary
12. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of
Employer Identification Number (EIN)
Paper Claim
Clean claim
Group Insurance
13. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
-50 - Bilateral Procedure
Vesicle
New patient
Social Security Number
14. 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).
Hairline
Sections
Dirty claim
Fee-for-Service
15. A pregnant woman who has had at least one previous pregnancy.
Employer Liability
Multigravida
Mandible
Liability insurance
16. Is the upper arm bone.
Malignant
Contracted Rates with MCOs
Fee Schedule
Humerus
17. The moon like white area at the base of the nail.
Review of Systems (ROS)
False ribs
lunula
HCPCS Level I codes
18. is defined as one who has not received any medical services within the last three years.
Preferred Provider Organization (PPO)
New Patient
itemized statement
Comminuted fracture
19. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Long bones
Malignant
Retention of Medical Records
Medigap (Medicare Supplemental Insurance)
20. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
itemized statement
Relative Value Payment Schedules Method
Evaluation and Management Review
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
21. Represent changes in the text or definition between the triangles.
Two triangular symbols (a
-99 - Multiple Modifiers
No ROM
essential modifiers
22. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Unlisted Procedures Procedures
The Good Samaritan Act
Benign (hypertension)
ulna
23. 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
Malignant
There are three layers to the skin
Malignant
axial skeleton
24. Consists of the skull - rib cage - and spine
MEDICARE Part A
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Pubic bone
axial skeleton
25. 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
Patient Confidentiality
Electronic Claim
Capitated Rates
Accident
26. numbers 8-10 - are attached to the sternum by cartilage
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Pelvis
False Claims Act (FCA)
False ribs
27. 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
Fee-for-Service
The Current Procedural Terminology (CPT)
Relative Value Payment Schedules Method
Categories
28. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Point-of-Service plan (POS)
Civil Monetary Penalties Law (CMPL)
Established Patient
29. Contains complete - necessary information - but is incorrect or illogical in some way.
Health Insurance Portability and Accountability Act (HIPAA)
The Patient Care Partnership (Patient's Bill of Rights)
Invalid claim
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
30. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
The Current Procedural Terminology (CPT)
Mutually Exclusive Edits
stand-alone codes
Established Patient
31. Discolored - flat lesion (freckles - tattoo marks)
Evaluation and Management Review
Abuse
Macule
Multigravida
32. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
History
Physician
National Correct Coding Initiative (NCCI)
Pre-certification
33. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
Abuse
False ribs
Contracted Rates with MCOs
Medigap (Medicare Supplemental Insurance)
34. The bone is broken and pierces an internal organ
-99 - Multiple Modifiers
Complicated
Macule
Categories
35. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Chief complaint (CC)
Full ROM
lunula
TRICARE
36. This is the inventory of the constitutional symptoms regarding the various body systems.
Pre-paid Health Plan
Location Methods
Review of Systems (ROS)
Accept assignment
37. 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
Column 1/Column 2 (previously called Comprehensive/Component) Edits
The Universal Claim Form
Clearinghouse
Provider Identification Number (PIN)
38. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Secondary malignancy
Explanation of Benefits (EOB)
Group Provider Number
Category III Codes CPT
39. 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
Physician
Lipocyte
MEDICARE Part A
Past - family and social history (PFSH)
40. 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
Inferior nasal conchae
Dirty claim
TRICARE
The St. Anthony Relative Value for Physicians (RVP)
41. Absence of hair from areas where it normally grows
Alphabetic Index (Volume 2)
Gangrene
Alopecia
Uncertain behavior
42. 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 -
Liability insurance
essential modifiers
Carcinoma (Ca) in situ
Deductible
43. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu
Blue Cross/Blue Shield Plans
essential modifiers
Pre-paid Health Plan
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
44. 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
Chief complaint
appendicular skeleton .
Medicaid
CPT SECTIONS.
45. Most billing-related cases are based on HIPAA and False Claims Act.
Capitated Rates
Abuse
Compliance Regulations
ligaments
46. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Relative Value Payment Schedules Method
Salter-Harris
ulna
History of present illness (HPI)
47. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Pre-certification
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Health Maintenance Organization (HMO)
Civil Monetary Penalties Law (CMPL)
48. 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
Retention of Medical Records
The Universal Claim Form
Liability insurance
Multigravida
49. 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
Undetermined
Patient Confidentiality
stand-alone codes
50. 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.
Group Provider Number
Personal Insurance
Full ROM
A plus sign (+)
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