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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. 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.






2. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t






3. 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.






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. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






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






7. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.






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






9. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






10. 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






11. Represents a new procedure or service code added since the previous edition of the manual.






12. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






13. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






14. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati






15. Number assigned to the physician by Medicare program.






16. 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






17. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






18. This is the inventory of the constitutional symptoms regarding the various body systems.






19. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






20. forms the roof of the nasal cavity.






21. A fracture of the epiphyseal plate in children.






22. 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.






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






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






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






26. 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






27. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.






28. 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






29.






30. Upper jaw bone






31. 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.






32. - 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






33. 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






34. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.






35. .. lower jaw bone.






36. 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






37. 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.






38. 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.






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






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






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






42. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.






43. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called






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






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






46. 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






47. Indicates add-on codes






48. 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






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






50. Number assigned by the insurance company to a physician who renders services to patients.