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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. 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






2. This modifier is used when the same procedure is performed on a mirror-image part of the body..






3. Absence of hair from areas where it normally grows






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






5. 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






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






7. Groove or crack like sore






8. 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






9. 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'.






10. 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.






11. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






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






13. Structural protein found in the skin and connective tissue






14. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






15. 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.






16. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.






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






18. Absence of hair from areas where it normally grows






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






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






21. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported






22. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






23. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.






24. Is the lower medial arm bone.






25. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual






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






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






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






29. 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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30. Upper jaw bone






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






32. - 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.






33. represents Exemption from the use of modifier -51






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






35. 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.






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






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






38. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






39. 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






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






41. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.






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






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 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)






45. 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.






46. 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






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






48. 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






49. 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.






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