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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 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






2. 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






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






4. the bone is crushed and or shattered.






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






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






7. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






8. Make up part of the interior of the nose.






9. 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.






10. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






11. Most billing-related cases are based on HIPAA and False Claims Act.






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






13. 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 -






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






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






16. 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






17. 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






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






19. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari






20. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






21. 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






22. 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.






23. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






24. Lower portion of the pelvic bone






25. Is the lower medial arm bone.






26. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






27. requires investigation and needs further clarification.






28. Absence of hair from areas where it normally grows






29. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






30. 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.






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






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






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






34. 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.






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






36. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






37. The physician must obtain this number in order to practice within a state.






38. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






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






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






41. 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'.






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






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






44. The bone is broken and pierces an internal organ






45. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






46. - 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.






47. 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






48. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






49. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






50. Describes the services billed and includes a breakdown of how the payment is determined