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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. uncertain whether benign or malignant; borderline malignancy






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






3. 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






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






5. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






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. The reason the patient came to see the physician.






8. 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






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






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






11. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.






12. 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






13. male of household is primary payer






14. 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.






15. 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






16. A fracture of the epiphyseal plate in children.






17. 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






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






19. 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






20. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






21. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from






22. 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






23. 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






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






25. Poisoning cannot be determined whether intentional or accidental.






26. .. lower jaw bone.






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






28. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






29. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h






30. open sore on the skin or mucous






31. 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






32. 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 -






33. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






34.






35. 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.






36. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






37. 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.






38. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






39. A fracture of the epiphyseal plate in children.






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






41. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.






42. 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.






43. The bone is broken and pierces an internal organ






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






45. Absence of hair from areas where it normally grows






46. represents Exemption from the use of modifier -51






47. 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.






48. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






49. 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.






50. Absence of hair from areas where it normally grows