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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 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






2. 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.






3. 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






4. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






5. .. lower jaw bone.






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






7. 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






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






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






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






11. The fractured area of bone collapses on itself.






12. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






13. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






14. 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






15. 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






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






17. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.






18. forms the two lower sides of the cranium.






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






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






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






22. 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






23. 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.






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






25. 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.






26. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.






27. Poisoning cannot be determined whether intentional or accidental.






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






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






30. 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






31. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an






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






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






34. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.






35. Any fracture occurring spontaneously as a result of disease.






36. Numbers 1-7 - attach directly to the sternum in the front of the body.






37. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






38. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas






39. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






40. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






41. 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






42. 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






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






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






45. Numbers 1-7 - attach directly to the sternum in the front of the body.






46. Forms the sides of the cranium






47. 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.






48. 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






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






50. make up part of the roof of the mouth