Medical Billing
The current name for the standard form used for professional billing in the United States
CMS-1500
The term that means “not cancerous”
Benign
The act that ensures the confidentiality and security of the patient, protecting against unauthorized disclosure of PHI
HIPAA
This system’s main functions are to break down food into small nutrients for the body to absorb and use and discard of waste products that are not absorbed
Digestive system
The number of digits in a CPT code
5
A statement sent by a health insurance company detailing how a medical claim was processed, which outlines the services received, the costs covered by insurance, and the amount the patient may owe
Explanation of Benefits (EOB)
Medical term for high blood pressure
Hypertension
The three words PHI stands for
Protected Health Information
The primary organ of the integumentary system and the largest organ in the human body
Skin
The long form of what the abbreviation CPT stands for
Current Procedural Terminology
Fixed monthly payments made to a provider for each patient enrolled under their care
Capitation
Suffix for surgical removal, excision, or cutting out of a body part, organ, or tissue
-ectomy
The entity that identifies, audits, and investigates fraud and abuse in Medicare and Medicaid
OIG - Office of Inspector General
Name of the long bone in the upper arm, running from the shoulder to the elbow
Humerus
The entity that publishes the CPT
The entity that acts as an intermediary between insurances and providers when submitting electronic claims
Clearinghouse
Medical term for removal of ovaries
(hint: oophor/o is the prefix for ovaries)
Oophorectomy
The law that prohibits against using anything of value (cash, gifts, etc.) in an effort to induce referrals for healthcare services.
Anti-Kickback Statute (AKS)
This fist-sized organ in the upper-left abdomen acts as a blood filter and immune system component by removing old or damaged blood cells, storing healthy platelets and white blood cells, and producing antibodies to fight infection.
Spleen
This category of codes contains temporary codes used for emerging technologies.
Category III
A _____ is a monthly payment to purchase and continue insurance coverage. A _______ is how much money you must pay before your insurance begins to pay for medical services. A _____ is a flat fee you must pay every time you see the doctor and _______ is a percentage you must pay in addition to other fees.
Premium, deductible, copayment, coinsurance
The medical term to describe a defective development of an organ or tissue
Hypoplasia
These edits prevent billing fraud by identifying unbundling of codes. Please list BOTH the abbreviation (short form) and what it stands for (long form).
NCCI (National Correct Coding Initiative)
Each muscle is surrounded by a connective tissue sheath called the epimysium. What is the name of the connective tissue outside of the epimysium that surrounds and separates the muscles?
Fascia
Name the all the sections of the CPT book in order.
Evaluation and Management
Anesthesia
Surgery
Radiology
Pathology and Laboratory
Medicine