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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. 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






2. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.






3. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






4. male of household is primary payer






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






6. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






7. 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






8. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






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






10. 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






11. 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






12. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






13. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).






14. requires investigation and needs further clarification.






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






16. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime






17. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....






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






19. A fracture of the epiphyseal plate in children.






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






21. 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






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






23. 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






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






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






26. 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






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






28. 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.






29. the bone is crushed and or shattered.






30. 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 -






31. Represent changes in the text or definition between the triangles.






32. Lower portion of the pelvic bone






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






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






35. 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






36. Poisoning cannot be determined whether intentional or accidental.






37. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.






38.






39. 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






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






41. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).






42. 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.






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






44. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.






45. 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






46. The bone is broken and pierces an internal organ






47. 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






48. 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






49. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






50. 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