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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. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






2. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.






3. death of tissue associated with loss of blood supply






4. 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






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






6. anterior to the temporal bones.






7. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






8. Groove or crack like sore






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






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






11. death of tissue associated with loss of blood supply






12. 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.






13. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






14. 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






15. 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.






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






17. 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.






18. Is the lower medial arm bone.






19. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






20. forms the two lower sides of the cranium.






21. 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.






22. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran






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






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






25. 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.






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






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






28. 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






29. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






30. 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






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






32. 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






33. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....






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






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






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






37. This is the inventory of the constitutional symptoms regarding the various body systems.






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






39. 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.






40. 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






41. 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






42. 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






43. 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






44. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr






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






46. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






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






48. A fat cell






49. Deficient in pigment (melanin)






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