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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. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from






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






3. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.






4. 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






5. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






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






7. Is when two insurance companies work together to coordinate payment of the benefits.






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






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. 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






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






12. 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.






13. the bone is crushed and or shattered.






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






15. 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






16. 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






17. Are conditions - situations - and services not covered by the insurance carrier.






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






19. 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






20. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






21. 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.






22. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






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






24. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.






25. 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






26. 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






27. 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....






28. The lower anterior part of the bone






29. 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






30. forms the roof of the nasal cavity.






31. Are conditions - situations - and services not covered by the insurance carrier.






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






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






34. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






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






36. Is when two insurance companies work together to coordinate payment of the benefits.






37. 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.






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






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






40. 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






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






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






43. paired bones at the corner of each eye that cradle the tear ducts.






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






45. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






46. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....






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






48. Contains complete - necessary information - but is incorrect or illogical in some way.






49. Lower portion of the pelvic bone






50. 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.