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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.






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






3. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






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






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






6. 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






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






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






9. 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






10. - 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.






11. Forms the sides of the cranium






12. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






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






14. 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:






15. 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.






16. means the provider agrees to accept what the insurance company approves as payment in full for the claim.






17. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.






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






19. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






20. '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






21. 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 -






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






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






24. The cuticle at the lower part of the nail and this is sometimes referred to as the






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






26. 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....






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






28. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.






29. 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....






30. Contains complete - necessary information - but is incorrect or illogical in some way.






31. make up part of the roof of the mouth






32. 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)






33. Is the lower medial arm bone.






34. 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.






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






36. 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.






37. Is the upper arm bone.






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






39. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






40. the bone is crushed and or shattered.






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






42. The poisoning was self-inflicted.






43. A fat cell






44. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






45. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






46. 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






47. 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.






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






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






50. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from