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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. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime






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






3. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






4. 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.






5. Absence of hair from areas where it normally grows






6. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






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






8. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.






9. 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..






10. 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






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






12. 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.






13. uncertain whether benign or malignant; borderline malignancy






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






15. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






16. 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






17.






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






19. 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






20. Is the upper arm bone.






21. 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






22. 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






23. forms the two lower sides of the cranium.






24. Any fracture occurring spontaneously as a result of disease.






25. 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






26. 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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27. The moon like white area at the base of the nail.






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






29. 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 -






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






31. solid - round or oval elevated lesion more than 1 cm in diameter






32. 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






33. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






34. Poisoning cannot be determined whether intentional or accidental.






35. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






36. The bone is broken and pierces an internal organ






37. 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.






38. means the provider agrees to accept what the insurance company approves as payment in full for the claim.






39. Cheekbone






40. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules






41. 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.






42. 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.






43. 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.






44. Is made up of the shoulder - collar - pelvic and arms and legs






45. Number assigned to the physician by Medicare program.






46. poisoning was inflicted by another person with intent to kill or injure






47. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






48. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.






49. Further classified as to primary - secondary - or carcinoma in situ.






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