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






2. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






3. 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






4. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.






5. Mild or controlled hypertension and no damage to the vascular system or organs.






6. Is the qualifying factor or factors that must be met before a patient receives benefits.






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






8. cancer that is localized and has not spread to adjacent tissues or distant parts of the body






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






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






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






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






13. 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.






14. 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






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






16. 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'.






17. 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






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






19. A fat cell






20. 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.






21. forms the roof of the nasal cavity.






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






23. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U






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






25. 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.






26. The fractured area of bone collapses on itself.






27. Numbers 1-7 - attach directly to the sternum in the front of the body.






28. This is not specified as benign or malignant in the diagnosis or medical record.






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






30. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






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






32. 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.






33. 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






34. 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






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






36. 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.






37. 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






38. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






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






40. 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'.






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






42. 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.






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






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






45. 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 -






46. 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.






47. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






48. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari






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






50. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)