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






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






4. 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






5. 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






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






7. Groove or crack like sore






8. the bone is broken and the ends are driven into each other.






9. The fractured area of bone collapses on itself.






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






11. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






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






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






14. 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....






15. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.






16. 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.






17. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.






18. A pregnant woman who has had at least one previous pregnancy.






19. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






20. uncertain whether benign or malignant; borderline malignancy






21. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






22. 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.






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






24. 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.






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






26. is a traumatic injury to a joint involving the soft tissue.






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






28. Deficient in pigment (melanin)






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






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






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






32. Represents a new procedure or service code added since the previous edition of the manual.






33. 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






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






35. 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






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






37. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






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






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






40. Forms the sides of the cranium






41. The lower anterior part of the bone






42. male of household is primary payer






43. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran






44. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.






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






46. Number assigned by the insurance company to a physician who renders services to patients.






47. 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






48. 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)






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






50. 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.