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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. Small collection of clear fluid;blister






2. 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






3. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






4. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari






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






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






7. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






8. 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.






9. The fractured area of bone collapses on itself.






10. The lower anterior part of the bone






11. 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






12. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....






13. anterior to the temporal bones.






14. 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






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






16. 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).






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






18. 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






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






20. 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.






21. represents Exemption from the use of modifier -51






22. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






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






24. 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






25. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






26. forms the two lower sides of the cranium.






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






28. 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






29. 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.






30. Lower portion of the pelvic bone






31. 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.






32. 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.






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






34.






35. The lower anterior part of the bone






36. 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






37. The moon like white area at the base of the nail.






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






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






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






41. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord






42. 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.






43. Superior and widest bone






44. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






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






46. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.

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47. 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 -






48. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.






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






50. 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