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






2. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






3. 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.






4. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






5. represents Exemption from the use of modifier -51






6. 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






7. 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






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






9. 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






10. Indicates add-on codes






11. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






12. 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






13. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






14. 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 -






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






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






17. Numbers 1-7 - attach directly to the sternum in the front of the body.






18. Small collection of clear fluid;blister






19. 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 -






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






21. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission






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






23. Structural protein found in the skin and connective tissue






24. 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






25. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






26. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.






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






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






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






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






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






32. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options






33. 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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34. Consists of the skull - rib cage - and spine






35. 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






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






37. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






38. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






39. 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






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






41. 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






42. 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.






43. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must






44. The lower anterior part of the bone






45. This modifier is used when the same procedure is performed on a mirror-image part of the body..






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






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






48. 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)






49. This is a set of information the physician gathers from the patient regarding the following:






50. 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.







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