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






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






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






4. A fracture of the epiphyseal plate in children.






5. Cheekbone






6. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the

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7. Is the upper arm bone.






8. Is the lower medial arm bone.






9. 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






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






11. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.






12. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.






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






14. 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






15. 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.






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






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






18. Is the lateral lower arm bone (in line with the thumb).






19. Upper jaw bone






20. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






21. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -






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






23. The fractured area of bone collapses on itself.






24. male of household is primary payer






25. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w






26. Is one who has no contract with the health insurance plan.






27. 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).






28. 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






29. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.






30. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.






31. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






32. 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.






33. 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.






34. major skin pigment






35. 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.






36. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.






37. forms the two lower sides of the cranium.






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






39. A pregnant woman who has had at least one previous pregnancy.






40. 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






41. is defined as one who has not received any medical services within the last three years.






42. The bone is broken and pierces an internal organ






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






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






45. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p






46. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called






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






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






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






50. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.







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