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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. 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






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






3. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






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






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






6. 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






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






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






9. Any fracture occurring spontaneously as a result of disease.






10. 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.






11. 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.






12. 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.






13. 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






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






15. 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.






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






17. 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.






18. male of household is primary payer






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






20. 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






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






22. 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'.






23. 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).






24. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






25. 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






26. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






27. 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






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






29. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






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






31. the bone is crushed and or shattered.






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






33. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






34. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






35. The bone is broken and pierces an internal organ






36. Is the upper arm bone.






37. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.

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






39. 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.






40. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






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






42. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.






43. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






44. 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.'






45. 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






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






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






48. 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.






49. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






50. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt