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






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






3. 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.






4. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






5. 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






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






7. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






8. 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.






9. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.






10. numbers 8-10 - are attached to the sternum by cartilage






11. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






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






13. Indicates add-on codes






14. Upper jaw bone






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






16. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.






17. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options






18. 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....






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






20. open sore on the skin or mucous






21. Is made up of the shoulder - collar - pelvic and arms and legs






22. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






23. 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.






24. 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.'






25. - 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.






26. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






27. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas






28. 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






29. 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.






30. Is the lower medial arm bone.






31. uncertain whether benign or malignant; borderline malignancy






32. 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.






33. 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






34. 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.






35. make up part of the roof of the mouth






36. 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






37. requires investigation and needs further clarification.






38. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






39. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






40. 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....






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






42. 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






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






44. The lower anterior part of the bone






45. Is when two insurance companies work together to coordinate payment of the benefits.






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






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






48. Is the qualifying factor or factors that must be met before a patient receives benefits.






49. 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.






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