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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. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.






2. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






3. Typically not used on the claim form unless the provider does not have an EIN.






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






5. 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






6. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation






7. 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.






8. 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






9. male of household is primary payer






10. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






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






12. Contains complete - necessary information - but is incorrect or illogical in some way.






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






14. 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.






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






16. .. lower jaw bone.






17. The physician must obtain this number in order to practice within a state.






18. 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






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






20. 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






21. 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.






22. 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.






23. 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






24. 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






25. Forms the anterior part of the skull and the forehead






26. 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.






27. 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






28. 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






29. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






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






31. Small collection of clear fluid;blister






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






33. Small collection of clear fluid;blister






34. 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).






35. Forms the anterior part of the skull and the forehead






36. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






37. 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






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






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






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






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






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






43. Upper jaw bone






44. 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






45. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






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






47. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






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






50. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.