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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. 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.






2. The bone is broken and pierces an internal organ






3. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth






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






5. Deficient in pigment (melanin)






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






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






8. 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.






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






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






11. 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






12. This is not specified as benign or malignant in the diagnosis or medical record.






13. 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






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






15. anterior to the temporal bones.






16. 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 -






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






18. This is the inventory of the constitutional symptoms regarding the various body systems.






19. 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.






20. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an






21. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






22. 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






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






24. Deficient in pigment (melanin)






25. forms the roof of the nasal cavity.






26. 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






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






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






29. 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.






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






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






32. 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....






33. 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






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






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






36. 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.






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






38. 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






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






40. Lower portion of the pelvic bone






41. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






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






43. 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 -






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






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






46. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay






47. Produce secretions that allow the body to be moisturized or cooled.






48. 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






49. Absence of hair from areas where it normally grows






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