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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.
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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 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






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






3. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






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






5. 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






6. Is an electronic or paper-based report of payment sent by the payer to the provider.






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






8. 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






9. major skin pigment






10. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.






11. Benign growth extending from the surface of the mucous membrane






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






13. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






14. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






15. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.






16. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






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






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






19. 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.






20. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






21. 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.






22. 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:






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






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






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






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






27. The poisoning was self-inflicted.






28. The main term in the index may by followed by terms within parenthesis.






29. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






30. The lower anterior part of the bone






31. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.






32. 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.






33. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






34. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances






35. 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....






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






37. The fractured area of bone collapses on itself.






38. 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






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






40. Absence of hair from areas where it normally grows






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






42. 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






43. The lower anterior part of the bone






44. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






45. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






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






47. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the

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48. make up part of the roof of the mouth






49. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p






50. Also known as Federal tax identification number. This is issued by the Internal Revenue Service