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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.
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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. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.

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2. Is the lower medial arm bone.






3. 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






4. This is the inventory of the constitutional symptoms regarding the various body systems.






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






6. 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






7. Make up part of the interior of the nose.






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






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






10. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






11. The physician must obtain this number in order to practice within a state.






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






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






14. open sore on the skin or mucous






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






16. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the

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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 brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.






19. 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






20. 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.






21. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....






22. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth






23. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






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






25. 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






26. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






27. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






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






29. the bone is crushed and or shattered.






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






31. forms the roof of the nasal cavity.






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






33. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord






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






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






36. 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.






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






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






39. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






40. 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






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






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






43. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.






44. Describes the services billed and includes a breakdown of how the payment is determined






45. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






46. The lower anterior part of the bone






47. 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.






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






49. The moon like white area at the base of the nail.






50. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re







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