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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. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






2. Is one who has no contract with the health insurance plan.






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






4. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






5. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






6. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






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






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






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






10. 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 -






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






12. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






13. Groove or crack like sore






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






15. represents Exemption from the use of modifier -51






16. - 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.






17. requires investigation and needs further clarification.






18. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






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






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






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






22.






23. the bone is crushed and or shattered.






24. 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






25. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






26. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.






27. A fracture of the epiphyseal plate in children.






28. Is the lower medial arm bone.






29. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.






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






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






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






33. 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 -






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






35. 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






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






37. Are conditions - situations - and services not covered by the insurance carrier.






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






39. represents Exemption from the use of modifier -51






40. This is not specified as benign or malignant in the diagnosis or medical record.






41. 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






42. 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






43. requires investigation and needs further clarification.






44. 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






45. 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.






46. 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






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






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






49. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






50. 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.