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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. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....






2. 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






3. Forms the anterior part of the skull and the forehead






4. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






5. 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.






6. - 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.






7. Forms the sides of the cranium






8. 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






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






10. 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






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






12. 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






13. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






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






15. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.






16. This is a set of information the physician gathers from the patient regarding the following:






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






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






19. poisoning was inflicted by another person with intent to kill or injure






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






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






22. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






23. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






24. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt






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






26. 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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27. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).






28. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must






29. 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






30. 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






31. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






32. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






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






34. make up part of the roof of the mouth






35. make up part of the roof of the mouth






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






37. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






38. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






39. 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.






40. Poisoning cannot be determined whether intentional or accidental.






41. 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.






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






43. 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.






44. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.






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






46. 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.






47. Indicates add-on codes






48. 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






49. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






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