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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. 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






2. 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).






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. 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.






5. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re






6. 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






7. Is a working diagnosis which is not yet established.






8. Indicates add-on codes






9. Upper jaw bone






10. 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






11. 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






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






13. Lower portion of the pelvic bone






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






15. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U






16. A pregnant woman who has had at least one previous pregnancy.






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






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






19. 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






20. The bone is broken and pierces an internal organ






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






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






23. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






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






25. 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.






26. 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.






27. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben






28. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






29. A pregnant woman who has had at least one previous pregnancy.






30. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






31. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






32. Cheekbone






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






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






35. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






36. Is the lateral lower arm bone (in line with the thumb).






37. anterior to the temporal bones.






38. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






39. Groove or crack like sore






40. 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






41. 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






42. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






43. - 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.






44. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






45. Absence of hair from areas where it normally grows






46. Structural protein found in the skin and connective tissue






47. The poisoning was self-inflicted.






48. 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 -






49. Small collection of clear fluid;blister






50. Upper jaw bone