cueFlash

Glossary of certification exam for Maggie

Start Studying! Add Cards ↓

Created by sweetlilmags

Deck Info

Description

Tags

Recent Users

Organization of affiliated providers' sites that offer joint healthcare services to subscribers.
IDS (integrated delivery system)
Contracted network of healthcare providers that provide care to subscribers for a discounted fee.
PPO (preferred provider organization)
Provides benefits to subscribers who are required to receive services from network providers.
EPO (exclusive provider organization)
Provides comprehensive healthcare services to voluntarily enrolled members on a prepaid basis.
HMO (health maintenance organization)
Patients can use the managed care panel of providers (paying discounted healthcare costs) or self-refer to out-of-network providers (and pay higher healthcare cost).
POS (point-of-service plan)
Means the patient and/or insured has authorized the payer to reimburse the provider directly?
assignment of benefits
Providers who do not accept assignment of Medicare benefits do not receive information included on the______, which is sent to the patient.
Medicare Summary Notice (EOB for Medicare)
The transmission of claims data to payers or clearinghouses is called claims...
submission
Which facilities processing of nonstandard claims data elements into standard data elements?
clearinghouse
A series of fixed-length records submitted to payers to bill for healthcare services is an electronic...
flat file format
Private-sector payers that process electronic claims is considered a....
covered entity
A claim that is rejected because of an error or omission is considered a....
open claim
Which supporting documentation is associated with submission of an insurance claim?
claims attachment
Which is a group health insurance policy provision that prevents multiple payers from reimbursing benefits covered by other policies?
coordination of benefits
The sorting of claims upon submission to collect and verify information about the patient and provider is called claims...
processing
Comparing the claim to payer edits and the patient's health plan benefits is part of the claims...
adjudication
Any procedure or service reported on a claim that is not included on the payer's master benefit list
non-covered benefit
What is an abstract of all recent claims filed on each patient, used by the payer to determine whether the patient is receiving concurrent care for the same condition by more that one provider
common data files
The fixed amount a patient pays every time they receive healthcare services.
co-payment
The physician must accept whatever a payer reimburses for procedures or services performed
participating provider
The parent whose birth month and day occurs earlier in the year is the primary policyholder.
birthday rule
The financial record source documented usually generated by a hospital
chargemaster
Requires providers to make certain written disclosures concerning all finance charges and related aspects of credit transactions
Truth in Lending Act
protects information collected by consumer reporting agencies
Fair Credit Reporting Act
An example on Medicare fraud...
billing for services that were not furnished and misrepresenting diagnoses to justify payment
An example of Medicare abuse
improper billing practices that result in Medicare payment when the claim is the legal responsibility of another third-party payer
One of the requirements that a participating provider must comply with is...
write off deductible and co-payment/co-insurance amounts, and accept as payment in full the BCBS-allowed fees
This program requires providers to adhere to managed care provisions
preferred provider network
One of the expectations that a nonparticipating provider has is to _____ for services rendered
obtain payment for the full fee charged
Special clause in an insurance contract that stipulates additional coverage over and above the standard contract
rider
______ is responsible for administering the Medicare program
CMS (centers of Medicaid and Medicare services)
Medicare Part __ reimburses institutional providers for inpatient, hospice, and some home health services
A
The Medicare enrollment period is...
Between January 1st and December 31st
A Medicare benefit period is defined as beginning the first day of hospitalization and ending when...
the patient has been out of the hospital for 60 consecutive days
Total number of Medicare lifetime reserve days
60
Medigap coverage is offered to Medicare beneficiaries by...
commercial payers
Forbidden as the result of legislation passed by some states
balance billing
Written document provided to a Medicare beneficiary by a provider prior to rendering a service that is unlikely to be reimbursed by Medicare
ABN (advance beneficiary notice)
The Office of Workers' Compensation Programs (OWCP) administers programs that provide the following...
medical treatment, vocational rehabilitation, and wage replacement benefits
receptors of the body
Mechanoreceptor

Proprioceptor

Thermoreceptor



The area behind the cornea
anterior chamber
This entity develops and publishes an annual plan that outlines the Medicare monitoring program
OIG (office of the inspector general)
This program was developed by CMS to promote national correct coding methods and to control inappropriate payment of Part B and hospital outpatient claims
NCCI (national correct coding initiative)
The RBRVS(resource based relative value scale) is a...
payment reform implemented in 1992
Which punctuation mark between codes in the index of the CPT manual indicated a range of codes are available?
hypen -
The symbol that indicated an add-on code in the CPT manual is:
+
PACU
Post-Anesthesia care unit
Endotracheal anesthesia
insertion of tube into nose/mouth then passing tube into trachea for ventilation
Epidural anesthesia
injection of anesthesia into epidural spaces between the vertebrae (epidural block)
Spinal anethesia
injection of lock anesthesia into the subarachnoid space around the spinal cord
General anesthesia
state of unconsciousness; combination of administrations, i.e. IM, rectal, IV, INH
Regional anesthesia
interrupts sensory nerve conduction in a specific region of the body (produced by a field block or nerve block)
Local anesthesia
topical anesthesia placed directly onto site (SQ injection of lidocaine into site)
PCA
patient controlled analgesia- allows patient to administer drug for pain control
Description of anesthesia formula
Base units (from RVG) based on CPT codes
Time units (often, 30 min. = 1 unit)
Modifiers (qualifying circumstances (99100-99140 and/or physical status (P1-P6)
B+T+M = Total units x $ (CF)


This term means the surgical removal of the fallopian tube
salpingectomy
This term is also known as homograft
allograft
This term means taste
gustatory
This term means abnormal thickening of this skin
pachyderma
The relaxation phase of the heartbeat...
diastole
This is the first portion of the small intestine
duodenum
part of the inner ear
vertibule
The covering of the chamber walls of the heart
endocardium
The act of turning upward, such as the hand turned palm upward:
supination
The middle layer of the skin, also known as the corium or true skin, is the:
dermis
This is the collar bone:
clavicle
Describes "separate procedure"
-incidental to another procedure
-reported if it is the only procedure performed
-reported if the procedure is unrelated to a more major procedure performed at the same time on the same site.



Sebaceous glands secrete...
sebum that lubricates skin/hair
Sudoriferous glands secrete...
Sweat
The outermost layer of skin:
epidermis
White area at base of nail plate
Lunula
Subcutaneous tissue is also known as:
adipose
This medical term means surgical incision into dead tissue:
escharotomy
Soft tissue around nail border is the:
paronychium
flat moles, freckles...
Macule
warts, lichen planus, elevated mole...
Papule
lipoma, erythema nodosum, enlarged lymph nodes...
Nodule
pimple, impetigo, abcess...
Pustule
hemangioma, neoplasm, lipoma
Tumor
psoriasis, seborrheic keratosis
Plaque
insect bites, allergic reaction
Wheal
herpes zoster (shingles), varicella (chicken pox)
Vesicle
blister
Bulla
dry skin
Scales
scab
Crust
athlete's foot, openings in corners of mouth
Fissure
blisters
Erosion
healed surgical wound
Scar
aged skin
Atrophy
missing tissue on heel, decubitus bedsore (pressure sore)
Ulcer
Medical term for itching
Pruritus
A stage III pressure ulcer involves:
full thickness loss of skin up to but not through fascia
This type of dermatitis may be exogenous or endogenous and is common in children and infants:
atopic
Psoriasis, pityriasis, and lichen planus are three types of this disorder:
papulosquamous
This skin infection is caused by group A beta-hemolytic Streptococcus, and the lesions appear as firm red spots with itching, burning, and tenderness:
fascitis
This type of herpes produce cold sores:
herpes simplex
This condition is caused by human papilloma virus:
verrucae
This type of tumor occurs in hair follicles:
keratoacanthoma
This type of superficial carcinoma is rarely metastatic:
squamous cell
Long bones (tubular)

-Length exceeds width of bone
-Broad at ends, such as thigh, lower leg, upper arm, and lower arm
Short bones (cuboidal):
Cubelike bones, such as carpals (wrist) and tarsals (ankle)
Flat bones
-Thin, flattened with curved surfaces
-Cover body parts, such as skull, scapula, sternum and ribs
Irregular bones:
Varied shapes, such as zygoma of face or vertebrae
Sesamoid bone:
-Rounded
-Found near joint, such as patella (kneecap)


Both ends of long bones-bulbular shape with muscle attachments:
Epiphysis
How many cervical vertebrae are there?
7
How many thoracic vertebrae are there?
12
How many lumbar vertebrae are there?
5
The medical term for the tailbone is...
Coccyx
True ribs:
1-7
False ribs:
8-10
Floating ribs:
11 and 12
Functions of the muscular system:
-Heat production
-Movement
-Posture
-Protection
-Shape



Striated muscles are:
-Voluntary (move muscles)
-Attaches to bone
Smooth/Visceral muscle:
-Linings such as bowel, urethra, and blood vessels
-Involuntary
Tendons anchor...
Muscle to Bone
Ligaments anchor...
Bones to Bones
Muscle Flexion:
Bend
Muscle Extension:
Straighten
Muscle Abduction:
Away
Muscle Adduction:
Toward
Muscle Rotation:
Turn on axis
Muscle Circumduction:
Circular
Pronation:
Turning palm downward or backward or act of lying face down
Muscle Hyperextension:
overextension of muscle
Inversion of muscle:
inward
Eversion of muscle
Outward
Arthrodesis
Surgical immobilization of a joint
Atrophy
Wasting away
Bunion
Hallux valgus, adnormal increase in size of metatarsal head that results in displacement of great toe
Chondral
Referring to cartilage
Closed fracture repair:
Not surgically opened with/without manipulation and with/without traction
Closed treatment:
Fracture site that is not surgically opened and visualized
Colles' fracture:
Fracture at lower end of radius that displaces bone posteriorly
Fasciectomy
Removal of band of fibrous tissue
Ganglion
Knot or knotlike mass
Internal/External fixation
Application of pins, wires, screws, placed externally or internally to immobilize a body part
Kyphosis
Humpback
Lordosis
Anterior curvature of the spine
Lumbodynia
Pain in the lumbar area
Manipulation or reduction
Alignment of a fracture or joint dislocation to normal position
Osteoarthritis
Degenerative condition of articular cartilage
Osteoclast
Absorbs or removes bone
Reduction
Replacement to normal position
Scoliosis
Lateral curvature of the spine
Skeletal traction
Application of pressure to by means of pins and/or wires inserted into the bone
Skin traction
Application of pressure to bone by means of tape applied to the skin
Subluxation
Partial dislocation
Tenorrhaphy
Suture repair of tendon
Trocar needle
Needle with a cannula that can be removed; used to puncture and withdraw fluid from a cavity
These bones are found near joints
sesamoid
Tubular is another name for these bones:
long
Zygoma is an example of this type of bone:
irregular
This term describes growth plate:
Epiphyseal
This is a depression on lateral hip surface into which head of femur fits:
acetabulum
Tip of the elbow:
Olecranon
This term describes an immovable joint:
Synarthrosis
A compound fracture is also known as:
open
This is a common bone disorder in postmenopausal women resulting from lower levels of calcium and potassium:
Osteoporosis
This inflammatory disease is progressive and leads to a rigid spinal column:
ankylosing spondylitis
This type of tumor arises from bone cells:
Osteogenic
This type of tumor is the most common type of malignant bone tumor that occurs in those over 40 and is a progressive and generally fatal:
multiple myeloma
A general muscle inflammation with an accompanying skin rash is:
dermatomyositis
A cartilage tumor that usually occurs in middle-aged and older individuals:
chondrosarcoma
Returning of bone to normal alignment is:
reduction
Result of overuse or overextension of a ligament is:
Sprain
Primary osteoarthritis is also known as:
idiopathic
Olfactory
Sense of smell
The 4 sinuses:
-Frontal
-Ethmoid
-Maxillary
-Sphenoid


Nose, pharynx, and larynx
Upper respiratory tract
Trachea, bronchial tree, and lungs
Lower respiratory tract
Asphyxia
Lack of oxygen
Ablation
Removal or destruction by cutting, chemicals, or electrocautery
Bacilli
Plural of bacillus, a rod-shaped bacteria
Crackle
Abnormal sound when breathing (heard on auscultation)
Croup
Acute viral infection (obstruction of larynx)
Dysphonia
Speech impairment
Emphysema
Air accumulated in organ or tissue
Epiglottidectomy
Excision of covering of larynx
Glottis
True vocal cords
Intramural
Within organ wall
Laryngeal web
Congenital abnormality of connective tissue between vocal cords
Lavage
Washing out
Nasal button
Synthetic circular disc used to cover a hole in the nasal septum
Orthopnea
Difficulty in breathing, relieved by assuming upright position
Percussion
Tapping with sharp blows as a diagnostic techique
Pertussis
Whooping cough
Pneumonia
Inflammation of lungs with consolidation
Pnemonolysis/Pneumolysis
Surgical seperationg of lung from chest wall to allow lung to collapse
Pulmonary edema
Accumulation of fluid in pulmonary tissues and air spaces
Pulmonary embolism
Thrombus or other foreign material lodged in pulmonary artery or one of its branches
Rales
An abnormal respiratory sound heard in auscultation, indication some pathologic condition
Sarcoidosis
Chronic inflammatory disease with nodules developing in lungs, lymph nodes, other organs
Segmentectomy
Surgical removal of the smaller subdivisions (segment) of lobes of a lung
Septoplasty
Surgical repair of nasal septum
Spirometry
Measuring breathing capacity
Thoracoplasty
Surgical procedure that removes ribs and thereby allows collapse of a lung
Transtracheal
Across trachea
Tuberculosis
Infection of the lung caused by bacteria (tubercle bacillus)
Interior of nose is divided by the:
Septum
Acute injury to alveolocapillary membrane that results in edema and atelectasis:
(ARDS) Adult Respiratory Distress Syndrome
Condition in which pus is in plueral space and is often a complication of pneumonia:
Emphyema
This condition is a result of accumulation of dust paritcles in lung:
pneumoconiosis
An irreversible airway obstructive disease in which symptoms are bronchial spasm, dyspnea, and wheezing:
COPD (Chronic obstructive pulmonary disease)
Cylindrical, varicose, and secular/cystic are examples of:
Bronchiectasis
Condition in which there is a loss of elasticity and enlargement of alveoli:
Emphysema
Definition of a chronic cough is one that lasts for more than this number of weeks...
3
A condition marked by an increase in carbon dioxide in arterial blood and decreased ability to breathe that can result in repiratory acidosis:
Hypercapnia
This condition often follows a viral infection and occurs in children under 2 years of age. Examples of various types of this condition are constrictive, proliferating, and obliterative.
Bronchiolitis
The leukocyes (5)
(Never Ever Be Late in the Morning)
-Neutrophils
-Eosinophils
-Basophils
-Lymphocytes
-Monocytes




Carries blood AWAY from the hear
Arteries
Carries blood TO the heart
Veins
Natures pacemaker is this node:
sinoatrial (SA node)
Node located on inter-atrial septum:
atrioventricular
The three layers of the chamber walls of the heart:
-endocardium
-myocardium
-epicardium

Septum that divides upper two chambers of the heart:
interatrial
Valve between right atrium and right ventricle:
Tricuspid
Outer two-layer covering of the heart:
Pericardium
The chambers of the heart that receive blood:
right and left atria
Lesion of carotid artery may lead to:
stroke
This blood pressure is hypertension:
140/90
Infective endocarditis is inflammation of the interior of the lining of the heart, and when caused by streptococci or staphylococci, the infection is:
bacterial
Angina pectoris is:
Chest pain
In this type of regurgitation there is a backflow of blood from left ventricle in left atrium:
Mitral
In this type of heart wall disorder, fibrous lesions form and encase the heart:
constrictive pericarditis
This condition is also know as congestive cardiomyopathy:
Dilated
This peripheral arterial disease most often occurs in young men who are heavy smokers:
Burger's disease
This cardiomyopathy results in a thickened interventricular septum:
Hypertrophic
Anterpartum
Before childbirth
Chorionic villus sampling
CVS, biopsy of outermost part of placenta
Cordocentesis
Procedure to obtain a fetal blood sample; also called a percutaneous umbilical blood sampling
Currettage
Scraping of a cavity using a spoon-shaped instrument
Cystole
Herniation of bladder into vagina
Ectopic
Pregnancy outside uterus
Ligation
Binding or tying off, as in constricting blood flow of a vessel or blinding fallopian tubes for sterilization
Multipara
More than one pregnancy
Oophprectomy
Surgical removal of overy(ies)
Perineum
A structure that connects fetus and mother during pregnancy
Postpartum
After childbirth
Primigravida
first pregnancy
Tocolysis
Repression of uterine contractions
The three layers of the uterus:
-perimetrium
-endometrium
-myometrium

Located at the lower end of uterus is the:
Cervix
Approximate gestation of a human fetus is:
266 days
Name of stage that describes development of fetus from fertilization to birth is:
prenatal
The three trimesters of gestation:
LMP-12 weeks, 13-27 weeks, 28 weeks-EDD
The most common solution used for intra-amniotic injections is:
saline
This type of dysmenorrhea is treated with nonsteroidal anti-inflammatory agents and progesterone:
primary
In this type of amenorrhea there is a cessation of menstruation:
secondary
metrorrhagia
bleeding between menstruation cycles
oligomenorrhea
Menstruation in excess of 6 weeks
menorrhagia
menstruation has an increased amount of duration and flow
Increased risks of breast cancer, and non-Hodgkin lymphoma exist with this condition:
endometriosis
This benign lesion is also known as uterine fibroids:
leiomyoma
Marginal, partial, and total are types of this condition:
placenta previa
Chordee
Condition resulting in penis being bent downward
Epididymis
Tube located at the top of the testes that store sperm
Orchiectomy
Castration, removal of testes
Orchiopexy
Surgical procedure to release undescended testis and fixate within scrotum
Priapism
Painful condition in which penis is constantly erect
Tumescence
State of being swollen
Varicocele
swelling of scrotal vein
Vasectomy
Removal of segment of vas deferens
Vasovasostomy
Reversal of a vasectomy

Add Cards

You must Login or Register to add cards