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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. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.






2. open sore on the skin or mucous






3. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on






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






5. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an






6. 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






7. anterior to the temporal bones.






8. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.






9. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






10. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






11. The fractured area of bone collapses on itself.






12.






13. The lower anterior part of the bone






14. make up part of the roof of the mouth






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






16. 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.






17. Deficient in pigment (melanin)






18. 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.






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






20. the bone is broken and the ends are driven into each other.






21. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






22. 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






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






24. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






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






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






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






28. the bone is broken and the ends are driven into each other.






29. Groove or crack like sore






30. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.






31. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay






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






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






34. A fracture of the epiphyseal plate in children.






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






36. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






37. forms the two lower sides of the cranium.






38. 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.






39. Benign growth extending from the surface of the mucous membrane






40. 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






41. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






42. 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.






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






44. 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.






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






46. 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






47. 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.






48. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






49. The poisoning was self-inflicted.






50. 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