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






2. 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






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






4. 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:






5. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -






6. 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






7. 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.






8. This is a set of information the physician gathers from the patient regarding the following:






9. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






10. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






11. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






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






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






14. 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






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






16. 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).






17. 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






18. 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






19. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers






20. 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






21. Consists of the skull - rib cage - and spine






22. 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.






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






24. 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






25. 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






26. Typically not used on the claim form unless the provider does not have an EIN.






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






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






29. 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






30. 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






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






32. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an






33. The physician must obtain this number in order to practice within a state.






34. 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






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






36. 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






37. open sore on the skin or mucous






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






39. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






40. The cuticle at the lower part of the nail and this is sometimes referred to as the






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






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






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






44. 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






45. 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.






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






47. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U






48. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission






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






50. 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.