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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. 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






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






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






4. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






5. The poisoning was self-inflicted.






6. Small collection of clear fluid;blister






7. The fractured area of bone collapses on itself.






8. 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






9. 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.






10. uncertain whether benign or malignant; borderline malignancy






11. 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






12. 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).






13. 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.'






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






15. Cheekbone






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






17. 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






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






19. 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....






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






21. requires investigation and needs further clarification.






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






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






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






25. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






26. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers






27. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






28. 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.






29. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






30. 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






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






32. 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.






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






34. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






35. 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.






36. major skin pigment






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






38. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.






39. 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






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






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






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






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






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






45. A fat cell






46. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






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






48. 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.'






49. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an






50. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime