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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. requires investigation and needs further clarification.






2. Small collection of clear fluid;blister






3. 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.






4. 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






5. 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






6. uncertain whether benign or malignant; borderline malignancy






7. male of household is primary payer






8. 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.






9. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






10. 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






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






12. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






13. Absence of hair from areas where it normally grows






14. 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






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






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






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






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






19. 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






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






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






22. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






23. Forms the sides of the cranium






24. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission






25. Groove or crack like sore






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






27. Is the lower medial arm bone.






28. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






29. death of tissue associated with loss of blood supply






30. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






31. 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.






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






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






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






35. - 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






36. 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






37. 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.






38. 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.






39. Describes the services billed and includes a breakdown of how the payment is determined






40. Lower portion of the pelvic bone






41. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






42. 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






43. 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.






44. the bone is crushed and or shattered.






45. A fat cell






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






47. Is when two insurance companies work together to coordinate payment of the benefits.






48. 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






49. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.






50. 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