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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. 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.






2. The moon like white area at the base of the nail.






3. 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






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






5. Indicates add-on codes






6. 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






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






8. the bone is crushed and or shattered.






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






10. Forms the sides of the cranium






11. Deficient in pigment (melanin)






12. 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.






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






14. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.






15. 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






16. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






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






18. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






19. 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:






20. 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.






21. 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






22. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord






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






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






25. 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






26. Is the qualifying factor or factors that must be met before a patient receives benefits.






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






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






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






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






31. 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






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






33. 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.'






34. 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.






35. 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






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






37. 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).






38. 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.






39. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






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






41. Cheekbone






42. 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






43. 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.






44. - 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.






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






46. Is the upper arm bone.






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






48. Poisoning cannot be determined whether intentional or accidental.






49. 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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50. 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