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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. 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






2. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






3. The bone is broken and pierces an internal organ






4. 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






5. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.






6. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






7. Indicates add-on codes






8. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






9. 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






10. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






11. Poisoning cannot be determined whether intentional or accidental.






12. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






13. - 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






14. 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






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






16. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






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






18. 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.






19. 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 -






20. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.






21. open sore on the skin or mucous






22. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






23. 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.






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






25. 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






26. major skin pigment






27. uncertain whether benign or malignant; borderline malignancy






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






29. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.


30. A fracture of the epiphyseal plate in children.






31. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.






32. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






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






34. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






35. 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.






36. Any fracture occurring spontaneously as a result of disease.






37. This modifier is used when the same procedure is performed on a mirror-image part of the body..






38. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.






39. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






40. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






41. '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






42. requires investigation and needs further clarification.






43. Consists of the skull - rib cage - and spine






44. make up part of the roof of the mouth






45. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






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






47. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.






48. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.






49. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






50. solid - round or oval elevated lesion more than 1 cm in diameter