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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. 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.






2. cancer that is localized and has not spread to adjacent tissues or distant parts of the body






3. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.






4. 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..






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






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






7. 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






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






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






10. requires investigation and needs further clarification.






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






12. Make up part of the interior of the nose.






13. 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






14. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt






15. 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






16. 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.






17. The bone is broken and pierces an internal organ






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






19. 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.






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






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






23. 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.






24. 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






25. 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.






26. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






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






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






29. 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.






30. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.






31. 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






32. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran






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






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






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






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






37. 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






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






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






40. 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.






41. 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






42. 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.






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






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






45. forms the roof of the nasal cavity.






46. 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.






47. Small collection of clear fluid;blister






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






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






50. A fat cell