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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






2. 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.






3. 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






4. make up part of the roof of the mouth






5. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services






6. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






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






8. Upper jaw bone






9. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules






10. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.






11. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






12. Indicates add-on codes






13. 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






14. Number assigned to the physician by Medicare program.






15. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






16. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.






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






18. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






19. 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






20. 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.






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






22. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






23. 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






24. 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.






25. 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






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






27. 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






28. 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.

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






30. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the

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31. 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






32. 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.






33. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






34. 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






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






36. 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






37. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






38. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






39. Cheekbone






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






41. 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






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






43. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari






44. Structural protein found in the skin and connective tissue






45. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas






46. 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






47. Small collection of clear fluid;blister






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






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






50. male of household is primary payer