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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. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.






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






3. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






4. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.






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






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






7. 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 -






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






9. 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.






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






11. 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.






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






13. 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






14. 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.






15. Groove or crack like sore






16. 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






17. 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.






18. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






19. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w






20. Benign growth extending from the surface of the mucous membrane






21. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






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. Forms the anterior part of the skull and the forehead






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






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






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






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






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






29. Is one who has no contract with the health insurance plan.






30. Represents a new procedure or service code added since the previous edition of the manual.






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






32. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth






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






34. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






35. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.






36. 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....






37. 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






38. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.






39. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.






40. 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






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






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






43. is defined as one who has not received any medical services within the last three years.






44. 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'.






45. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






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






47. Forms the sides of the cranium






48. 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






49. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features






50. 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.