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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. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






2. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






3. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.






4. Forms the sides of the cranium






5. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation






6. Indicates add-on codes






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






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






9. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






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






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






12. Number assigned by the insurance company to a physician who renders services to patients.






13. Is one who has no contract with the health insurance plan.






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






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






16. 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.






17. 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.






18. 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






19. The poisoning was self-inflicted.






20. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






21. 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






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






23. forms the two lower sides of the cranium.






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






25. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.






26. 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






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






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






29. 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.






30. solid - round or oval elevated lesion more than 1 cm in diameter






31. 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






32. 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.






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






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






35. Is an electronic or paper-based report of payment sent by the payer to the provider.






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






37. 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






38. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






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






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






41. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






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






43. 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






44. 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






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






46. represents Exemption from the use of modifier -51






47. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






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






49. 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






50. 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