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Medical Billing And Coding Vocab

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  • Answer 50 questions in 15 minutes.
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  • Match each statement with the correct term.
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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. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).






2. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.






3. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






4. are small with irregular shapes. They are found in the wrist and ankle.






5. Represent changes in the text or definition between the triangles.






6. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






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






8. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






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






10. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.






11. 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






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






13. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.






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






15. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re






16. Number assigned to the physician by Medicare program.






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






18. Noninvasive - non-spreading - nonmalignant






19. .. lower jaw bone.






20. Is an electronic or paper-based report of payment sent by the payer to the provider.






21. 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.






22. forms the roof of the nasal cavity.






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






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






25. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






26. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






27. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






28. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






29. 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






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






31. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






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






33. This is the inventory of the constitutional symptoms regarding the various body systems.






34. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






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






36. Forms the sides of the cranium






37. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.






38. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






39. means the provider agrees to accept what the insurance company approves as payment in full for the claim.






40. The lower anterior part of the bone






41. 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.






42. 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






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






44. Is the qualifying factor or factors that must be met before a patient receives benefits.






45. 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






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






47. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.






48. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






49. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






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







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