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






2. Consists of the skull - rib cage - and spine






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






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






5. Consists of the skull - rib cage - and spine






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






7. requires investigation and needs further clarification.






8. Is the upper arm bone.






9. 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.






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






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






12. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






13. 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






14. - 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.






15. 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






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






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






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






19. 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






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






21. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






22. The reason the patient came to see the physician.






23. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






24. 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.






25. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






26. A fracture of the epiphyseal plate in children.






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






28. forms the two lower sides of the cranium.






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






30. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers






31. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






32. 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






33. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ






34. 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.






35. 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.






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






37. Mild or controlled hypertension and no damage to the vascular system or organs.






38. Indicates add-on codes






39. represents Exemption from the use of modifier -51






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






41. 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.






42. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






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






44. The poisoning was self-inflicted.






45. 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.






46. 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






47. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






48. uncertain whether benign or malignant; borderline malignancy






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






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