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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. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w






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






3. numbers 8-10 - are attached to the sternum by cartilage






4. anterior to the temporal bones.






5. is defined as one who has not received any medical services within the last three years.






6. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






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






8. 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






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






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






11. 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






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






13. male of household is primary payer






14. Discolored - flat lesion (freckles - tattoo marks)






15. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.






16. Number assigned to the physician by Medicare program.






17. 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.






18. Make up part of the interior of the nose.






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






20. 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






21. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben






22. 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






23. 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






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






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






26. - 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






27. Upper jaw bone






28. A fat cell






29. 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






30. Law passed by the federal government to prosecute cases of Medicaid fraud.






31. - 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.






32. 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 -






33. Superior and widest bone






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






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






36. 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






37. 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.






38. 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






39. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






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






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






42. Law passed by the federal government to prosecute cases of Medicaid fraud.






43. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






44. cancer that is localized and has not spread to adjacent tissues or distant parts of the body






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






46. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.






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. Produce secretions that allow the body to be moisturized or cooled.






49. Cheekbone






50. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.