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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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 a set of information the physician gathers from the patient regarding the following:






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






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. 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.






5. 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






6. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ






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






8. 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






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






10. 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.






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






12. Noninvasive - non-spreading - nonmalignant






13. Law passed by the federal government to prosecute cases of Medicaid fraud.






14. Describes the services billed and includes a breakdown of how the payment is determined






15. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






16. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.






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






18. Absence of hair from areas where it normally grows






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






20. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






21. uncertain whether benign or malignant; borderline malignancy






22. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must






23. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






24. 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






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






26. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






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






28. 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






29. 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.






30. make up part of the roof of the mouth






31. 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






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






33. - 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.






34. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






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






36. Superior and widest bone






37. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.






38. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






39. Law passed by the federal government to prosecute cases of Medicaid fraud.






40. 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.






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






42. 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






43. Number assigned to the physician by Medicare program.






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






45. The fractured area of bone collapses on itself.






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






47.






48. open sore on the skin or mucous






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






50. Superior and widest bone







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