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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. Law passed by the federal government to prosecute cases of Medicaid fraud.






2. major skin pigment






3. 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






4. 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.'






5. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime






6. are small with irregular shapes. They are found in the wrist and ankle.






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






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






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






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






11. major skin pigment






12. 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.






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






14. 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.






15. 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'.






16. Superior and widest bone






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






18. 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






19. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






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






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






22. 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






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






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






25. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






26. uncertain whether benign or malignant; borderline malignancy






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






28. 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






29. 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






30. 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.






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






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






33. the bone is crushed and or shattered.






34. forms the two lower sides of the cranium.






35. 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






36. uncertain whether benign or malignant; borderline malignancy






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






38. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.






39. represents Exemption from the use of modifier -51






40. 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






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






42. 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.






43. male of household is primary payer






44. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.






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






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






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






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






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






50. 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







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