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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.
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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. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






2. The lower anterior part of the bone






3. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h






4. 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






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






6. This is not specified as benign or malignant in the diagnosis or medical record.






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






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






9. 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.






10. 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.






11. Numbers 1-7 - attach directly to the sternum in the front of the body.






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






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






14. The main term in the index may by followed by terms within parenthesis.






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






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






17. forms the roof of the nasal cavity.






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






19. major skin pigment






20. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






21. 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.






22. 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.






23. 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.






24. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






25. 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






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






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






28. Are conditions - situations - and services not covered by the insurance carrier.






29. 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






30. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






31. 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






32. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






33. 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






34. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






35. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






36. 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).






37. 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






38. numbers 8-10 - are attached to the sternum by cartilage






39. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






40. 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.






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






42. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances






43. make up part of the roof of the mouth






44. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






45. 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.






46. Number assigned to the physician by Medicare program.






47. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






48. forms the roof of the nasal cavity.






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






50. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service