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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
  • If you are not ready to take this test, you can study here.
  • 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. The reason the patient came to see the physician.






2. Is when two insurance companies work together to coordinate payment of the benefits.






3. 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






4. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






5. 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






6. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






7. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.






8. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






9. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






10. paired bones at the corner of each eye that cradle the tear ducts.






11. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






12. Typically not used on the claim form unless the provider does not have an EIN.






13. 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






14. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.






15. Pre-determined set of benefits covered under one set annual fee.






16. 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.






17. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.






18. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






19. the bone is crushed and or shattered.






20. 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






21. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features






22. 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 -






23. 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






24. most synarthroses are immovable joints held together by fibrous tissue.






25. 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






26. Benign growth extending from the surface of the mucous membrane






27. Further classified as to primary - secondary - or carcinoma in situ.






28. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.






29. the bone is broken and the ends are driven into each other.






30. 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






31. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h






32. 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..






33. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






34. 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






35. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health






36. 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






37. Numbers 1-7 - attach directly to the sternum in the front of the body.






38. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






39. 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






40. the bone is crushed and or shattered.






41. The reason the patient came to see the physician.






42. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported






43. Poisoning cannot be determined whether intentional or accidental.






44. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






45. 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






46. 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






47. Deficient in pigment (melanin)






48. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






49. Superior and widest bone






50. 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