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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 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.






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






3. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






4. forms the two lower sides of the cranium.






5. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






6. 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.






7. anterior to the temporal bones.






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






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






10. 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.






11. 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'.






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






13. Further classified as to primary - secondary - or carcinoma in situ.






14. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.






15. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






16. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






17. are small with irregular shapes. They are found in the wrist and ankle.






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






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






20. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






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






22. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






23. 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






24. The fractured area of bone collapses on itself.






25. 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.






26. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






27. Number assigned to the physician by Medicare program.






28. 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






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






31. The main term in the index may by followed by terms within parenthesis.






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






33. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.






34. represents Exemption from the use of modifier -51






35. is a traumatic injury to a joint involving the soft tissue.






36. 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






37. Lower portion of the pelvic bone






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






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






40. 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






41. .. lower jaw bone.






42. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






43. Upper jaw bone






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






45. 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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46. the bone is crushed and or shattered.






47. open sore on the skin or mucous






48. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






49. 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.






50. Poisoning cannot be determined whether intentional or accidental.