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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. 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.






2. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual






3. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t






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






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






6. 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.






7. 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






8. 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






9. - 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






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






11. Lower portion of the pelvic bone






12. 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....






13. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






14. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must






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






16. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben






17. anterior to the temporal bones.






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






19. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






20. 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






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






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






23. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






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






25. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features






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






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






28. major skin pigment






29. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






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






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






32. 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....






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






34. Upper jaw bone






35. 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






36. 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






37. requires investigation and needs further clarification.






38. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






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






40. 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.






41. Is the lower medial arm bone.






42. most synarthroses are immovable joints held together by fibrous tissue.






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






44. Upper jaw bone






45. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






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






47. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






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






49. Forms the anterior part of the skull and the forehead






50. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..