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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 a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.






2. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.






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






4. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.






5. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






6. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.






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






8. Upper jaw bone






9. Is the lateral lower arm bone (in line with the thumb).






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






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






12. Groove or crack like sore






13. 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....






14. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






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






16. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services






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






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






19. The poisoning was self-inflicted.






20. Pre-determined set of benefits covered under one set annual fee.






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






22. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.






23. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






24. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p






25. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re






26. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






27. The lower anterior part of the bone






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






29. is a traumatic injury to a joint involving the soft tissue.






30. 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'.






31. 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.






32. Poisoning cannot be determined whether intentional or accidental.






33. 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






34. The poisoning was self-inflicted.






35. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






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






37. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.






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






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






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






41. forms the roof of the nasal cavity.






42. 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.






43. The fractured area of bone collapses on itself.






44. 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.






45. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.






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






47. 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






48. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






49. 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






50. 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