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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 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.






2. 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






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






4. Groove or crack like sore






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






6. Cheekbone






7. uncertain whether benign or malignant; borderline malignancy






8. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






9. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay






10. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health






11. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.






12. 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....






13. 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.






14. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






15. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






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






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






18. Is the upper arm bone.






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






20. Deficient in pigment (melanin)






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






22. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.






23. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported






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






25. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






26. most synarthroses are immovable joints held together by fibrous tissue.






27. 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






28. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






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






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






31. Is a working diagnosis which is not yet established.






32. 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).






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






34. 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






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






36. 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






37. 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






38. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






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






40. Deficient in pigment (melanin)






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






42. 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.






43. 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.






44. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






45. death of tissue associated with loss of blood supply






46. 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.






47. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






48. 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.






49. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






50. 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