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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.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
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. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Malignant
National Correct Coding Initiative (NCCI)
Undetermined
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
2. Noninvasive - non-spreading - nonmalignant
Category II Codes CPT
Polyp
Sphenoid Bones
Benign
3. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.
-26 - Professional Component
co-payment
Physician
Vesicle
4. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Tabular List (Volume 1)...
CPT SECTIONS.
TRICARE PLANS
5. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
itemized statement
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Alopecia
Ischium
6. Mild or controlled hypertension and no damage to the vascular system or organs.
Capitated Rates
Benign (hypertension)
Point-of-Service plan (POS)
Preferred Provider plan
7. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o
Section 3 Index to External Causes of Injury (E codes)
nonessential modifiers
lunula
Health Care Financing Administration Common Procedure Coding System
8. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Collagen
Inferior nasal conchae
Hairline
Add-on codes
9. 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
Abuse
Past - family and social history (PFSH)
False Claims Act (FCA)
Outpatient
10. Make up part of the interior of the nose.
Dirty claim
Electronic Claim
MEDICAID COVERAGE
Inferior nasal conchae
11. 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
Carpals
Health Maintenance Organization (HMO)
Medically needy
Accident
12. 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.
Rejected claim
Fee Schedule
sprain
-26 - Professional Component
13. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Participating physician
Surgical Package
Multigravida
Accident
14. 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
Group Insurance
Limited ROM
Benign (hypertension)
Gender rule
15. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.
The Current Procedural Terminology (CPT)
Pelvis
Paper Claim
Contracted Rates with MCOs
16. 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)
ulna
Nodule
Pre-certification
17. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.
TRICARE PLANS
Pre-determination
-99 - Multiple Modifiers
encounter form
18. 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
Preferred Provider plan
Commercial Carriers
Evaluation and Management Review
appendicular skeleton .
19. 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.
Medicare Claim Status
Gangrene
Section 3 Index to External Causes of Injury (E codes)
Paper Claim
20. Any fracture occurring spontaneously as a result of disease.
Zygoma
MEDICARE Part C
Pathologic
itemized statement
21. 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
Assault
Outpatient
Explanation of Benefits (EOB)
premium
22. 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
Employee Liability
Qualified diagnosis
Full ROM
Abuse
23. forms the two lower sides of the cranium.
Temporal Bone
nonessential modifiers
Medigap (Medicare Supplemental Insurance)
Alphabetic Index (Volume 2)
24. poisoning was inflicted by another person with intent to kill or injure
Assault
The St. Anthony Relative Value for Physicians (RVP)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Flat bones
25. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Accept assignment
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
26. 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
History
Pubic bone
Medicare Claim Status
27. 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'.
Uncertain behavior
Pre-authorization
premium
Employee Liability
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
-99 - Multiple Modifiers
New Patient
Compression fracture
The Patient Care Partnership (Patient's Bill of Rights)
29. Lower portion of the pelvic bone
Ischium
Established patient
sprain
Outpatient
30. requires investigation and needs further clarification.
Medically needy
-26 - Professional Component
CPT SECTIONS.
Rejected claim
31. 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)
Clean claim
Established Patient
Hairline
32. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
essential modifiers
Pubic bone
Wheal
eponychium
33. 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
Provider Identification Number (PIN)
Pubic bone
Zygoma
Blue Cross/Blue Shield Plans
34. 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.
Established Patient
premium
Sphenoid Bones
No ROM
35. 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.
MEDICARE Part B
Patient Confidentiality
Pre-authorization
Preferred Provider plan
36. uncertain whether benign or malignant; borderline malignancy
No ROM
Uncertain behavior
Salter-Harris
bullet (a
37. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ
Workers Compensation
The Universal Claim Form
Invalid claim
Chief complaint (CC)
38. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Eligibility
Blue Cross/Blue Shield Plans
Birthday rule
Humerus
39. 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
-99 - Multiple Modifiers
Section 3 Index to External Causes of Injury (E codes)
Subcategories
Health Care Financing Administration Common Procedure Coding System
40. 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.
Musculoskeletal System
-32 - Mandated Services
-90 - Reference (Outside) Laboratory
Malignant
41. 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
Established patient
Sphenoid Bones
Fee Schedule
Patient Confidentiality
42. anterior to the temporal bones.
Tabular List (Volume 1)...
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Chapters
Sphenoid Bones
43. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Medicaid
Colles
Secondary malignancy
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
44. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Location Methods
Sections
Benign (hypertension)
The Integumentary System
45. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Zygoma
Fee Schedule
Category II Codes CPT
Complicated
46. 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
Sections
Employer Liability
Coinsurance
Chief complaint (CC)
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
Ischium
Sub classification
Paper Claim
State License Number
48. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Health Maintenance Organization (HMO)
axial skeleton
bullet (a
Employer Identification Number (EIN)
49. 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
Sections
Capitated Rates
Pre-authorization
Advance Beneficiary Notice
50. Groove or crack like sore
Clearinghouse
Short bones
Group practice
Fissure
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