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






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






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






4. paired bones at the corner of each eye that cradle the tear ducts.






5. most synarthroses are immovable joints held together by fibrous tissue.






6. 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






7. the bone is crushed and or shattered.






8. requires investigation and needs further clarification.






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






10. 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






11. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






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






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






14. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t






15. 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






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






17. 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






18. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.






19. Is the lower medial arm bone.






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






21. 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.






22. 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.






23. Represent changes in the text or definition between the triangles.






24. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must






25. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






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






27. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






28. 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






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






30. 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.






31. the bone is crushed and or shattered.






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






33. 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






34. numbers 8-10 - are attached to the sternum by cartilage






35. major skin pigment






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






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






38. 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)






39. Further classified as to primary - secondary - or carcinoma in situ.






40. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt






41. 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






42. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.






43. 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.






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






45. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.






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






47. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






48. 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






49. 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.






50. 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