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






2. 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






3. represents Exemption from the use of modifier -51






4. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






5. 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






6. 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.






7. Lower portion of the pelvic bone






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






9. Groove or crack like sore






10. 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






11. 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






12. The cuticle at the lower part of the nail and this is sometimes referred to as the






13. means the provider agrees to accept what the insurance company approves as payment in full for the claim.






14. 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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15. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the

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16. the bone is broken and the ends are driven into each other.






17. paired bones at the corner of each eye that cradle the tear ducts.






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






19. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.






20. 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 -






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






22. 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






23. 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






24. 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.






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






26. major skin pigment






27. - 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.






28. 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....






29.






30. 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.






31. Small collection of clear fluid;blister






32. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






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






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






35. 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.






36. 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....






37. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






38. death of tissue associated with loss of blood supply






39. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






40. 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






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






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






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






44. 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






45. 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.






46. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.






47. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..






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






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






50. .. lower jaw bone.