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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 original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.






2. 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






3. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






4. Mild or controlled hypertension and no damage to the vascular system or organs.






5. Contains complete - necessary information - but is incorrect or illogical in some way.






6. 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






7. The moon like white area at the base of the nail.






8. open sore on the skin or mucous






9. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






10. This is not specified as benign or malignant in the diagnosis or medical record.






11. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.






12. Is the upper arm bone.






13. Forms the anterior part of the skull and the forehead






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. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






16. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....






17. Represents a new procedure or service code added since the previous edition of the manual.






18. A fat cell






19. is a traumatic injury to a joint involving the soft tissue.






20. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






21. Is made up of the shoulder - collar - pelvic and arms and legs






22. poisoning was inflicted by another person with intent to kill or injure






23. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr






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






25. 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






26. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.






27. 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.






28. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.






29. Noninvasive - non-spreading - nonmalignant






30. The main term in the index may by followed by terms within parenthesis.






31. Most billing-related cases are based on HIPAA and False Claims Act.






32. 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.






33. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






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






35. 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






36. Is the lower medial arm bone.






37. Number assigned by the insurance company to a physician who renders services to patients.






38. uncertain whether benign or malignant; borderline malignancy






39. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






40. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






41. Describes the services billed and includes a breakdown of how the payment is determined






42. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin






43. Is one who has no contract with the health insurance plan.






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






45. - 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.






46. Indicates add-on codes






47. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati






48. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord






49. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






50. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ