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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. 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....






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






3. Mild or controlled hypertension and no damage to the vascular system or organs.






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






5. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas






6. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr






7. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules






8. 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






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






10. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






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. 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






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






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






15. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.






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






17. 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.






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






19. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






20. 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






21. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






22. - 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






23. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






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






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






26. 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....






27. The lower anterior part of the bone






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






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






30. Is made up of the shoulder - collar - pelvic and arms and legs






31. 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.






32. 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.






33. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.






34. requires investigation and needs further clarification.






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






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






37. Is the lower medial arm bone.






38. 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






39. Superior and widest bone






40. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






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






42. Cheekbone






43. 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






44. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






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






46. Forms the sides of the cranium






47. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.






48. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






49. Indicates add-on codes






50. 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 -