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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.
  • 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 a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






2. 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






3. 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.






4. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.






5. 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






6. Pre-determined set of benefits covered under one set annual fee.






7. 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






8. Noninvasive - non-spreading - nonmalignant






9. requires investigation and needs further clarification.






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






11. Represent changes in the text or definition between the triangles.






12. This is a set of information the physician gathers from the patient regarding the following:






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






14. 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.






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. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






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






18. The lower anterior part of the bone






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






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






21. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.






22. A fat cell






23. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






24.






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






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






27. 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.






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






29. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -






30. 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).






31. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






32. This modifier is used when the same procedure is performed on a mirror-image part of the body..






33. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






34. anterior to the temporal bones.






35. 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.






36. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






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






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






39. 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:






40. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






41. 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






42. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on






43. 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






44. Deficient in pigment (melanin)






45. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w






46. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.






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






48. Poisoning cannot be determined whether intentional or accidental.






49. 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.






50. male of household is primary payer






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