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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr






2. 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.






3. 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.






4. Is the upper arm bone.






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






6. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






7. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






8. 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.






9. 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






10. 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






11. 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






12. major skin pigment






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






14. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr






15. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.






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






17. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






18. 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.






19. This modifier is used when the same procedure is performed on a mirror-image part of the body..






20. Law passed by the federal government to prosecute cases of Medicaid fraud.






21. Noninvasive - non-spreading - nonmalignant






22. 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






23. Absence of hair from areas where it normally grows






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






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






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






27. 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






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






29. Forms the sides of the cranium






30. The poisoning was self-inflicted.






31. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services






32. make up part of the roof of the mouth






33. The bone is broken and pierces an internal organ






34. 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






35. 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






36. Discolored - flat lesion (freckles - tattoo marks)






37. 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






38. 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






39. forms the two lower sides of the cranium.






40. The moon like white area at the base of the nail.






41. 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.






42. 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






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






44. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






45. Deficient in pigment (melanin)






46. 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).






47. A fracture of the epiphyseal plate in children.






48. Represents a new procedure or service code added since the previous edition of the manual.






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






50. 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.