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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.
  • 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. 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






2. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






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






4. Number assigned to the physician by Medicare program.






5. Is when two insurance companies work together to coordinate payment of the benefits.






6. Describes the services billed and includes a breakdown of how the payment is determined






7. 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.






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






9. 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






10. 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.'






11. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






12. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






13. 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.






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






15. Describes the services billed and includes a breakdown of how the payment is determined






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






17. 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.






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






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






20. 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






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






22. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health






23. 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






24. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U






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






26. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari






27. The poisoning was self-inflicted.






28. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






29. 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.






30. open sore on the skin or mucous






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






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






33. Absence of hair from areas where it normally grows






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






35. Is the qualifying factor or factors that must be met before a patient receives benefits.






36. Consists of the skull - rib cage - and spine






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






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






39. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






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






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






42. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






43. 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






44. Is the upper arm bone.






45. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






46. 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:






47. 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






48. is defined as one who has not received any medical services within the last three years.






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






50. Poisoning cannot be determined whether intentional or accidental.