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






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






3. 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






4. 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






5. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.






6. Numbers 1-7 - attach directly to the sternum in the front of the body.






7. Further classified as to primary - secondary - or carcinoma in situ.






8. 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






9. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






10. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.






11. Lower portion of the pelvic bone






12. open sore on the skin or mucous






13. .. lower jaw bone.






14. - 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.






15. uncertain whether benign or malignant; borderline malignancy






16. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






17. Poisoning cannot be determined whether intentional or accidental.






18. solid - round or oval elevated lesion more than 1 cm in diameter






19. Pre-determined set of benefits covered under one set annual fee.






20. 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.'






21. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






22. 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.






23. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran






24. 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






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






26. Is the upper arm bone.






27. the bone is crushed and or shattered.






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






29. 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






30. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord






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






32. 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






33. forms the roof of the nasal cavity.






34.






35. death of tissue associated with loss of blood supply






36. 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






37. 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.






38. 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.






39. Superior and widest bone






40. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






41. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






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






43. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






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






45. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






46. forms the roof of the nasal cavity.






47. .. lower jaw bone.






48. 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.






49. Are composed of three-digit codes representing a single disease or condition.






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