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






2. Make up part of the interior of the nose.






3. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






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






5. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






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






7. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ






8. 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).






9. Noninvasive - non-spreading - nonmalignant






10. The bone is broken and pierces an internal organ






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






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






14. 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






15. A fracture of the epiphyseal plate in children.






16. The lower anterior part of the bone






17. male of household is primary payer






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






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






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






21. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






22. 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.






23. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






24. 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






25. 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.






26. 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






27. 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 -






28. 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






29. Is a working diagnosis which is not yet established.






30. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






31. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health






32. Structural protein found in the skin and connective tissue






33. Structural protein found in the skin and connective tissue






34. numbers 8-10 - are attached to the sternum by cartilage






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






36. Law passed by the federal government to prosecute cases of Medicaid fraud.






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






38. 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.






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






40. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






41. The fractured area of bone collapses on itself.






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






43. 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






44. 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.






45. 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.






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






47. 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'.






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






49. Small collection of clear fluid;blister






50. 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