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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. Forms the anterior part of the skull and the forehead






2. make up part of the roof of the mouth






3. represents Exemption from the use of modifier -51






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






5. 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.






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






7. Typically not used on the claim form unless the provider does not have an EIN.






8. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






9. Deficient in pigment (melanin)






10. 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.






11. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.






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






13. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin






14. 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






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






16. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






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






18. Cheekbone






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






20. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






21. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






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






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






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






25. 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






26. 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






27. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.






28. Is made up of the shoulder - collar - pelvic and arms and legs






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






30. 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.






31. Lower portion of the pelvic bone






32. open sore on the skin or mucous






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






34. 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.






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






36. 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






37. 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






38. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






39. 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.






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






41. 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..






42. 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






43. Is a working diagnosis which is not yet established.






44. 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






45. 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.






46. Number assigned to the physician by Medicare program.






47. The fractured area of bone collapses on itself.






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






49. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






50. 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.