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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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 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.






2. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay






3. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






4. .. lower jaw bone.






5. 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






6. 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






7. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.






8. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






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






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






11. The main term in the index may by followed by terms within parenthesis.






12. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






13. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






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






15. Are composed of three-digit codes representing a single disease or condition.






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






17. 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.






18. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission






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






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






21. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






22. Discolored - flat lesion (freckles - tattoo marks)






23. Number assigned to the physician by Medicare program.






24. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






25. the bone is crushed and or shattered.






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






27. 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.






28. 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






29. Forms the sides of the cranium






30. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






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






32. 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.






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






34. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.






35. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






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






37. 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






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






39. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






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






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






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






43. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






44. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






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






46. 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






47. Indicates add-on codes






48. 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






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






50. Most billing-related cases are based on HIPAA and False Claims Act.







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