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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. 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.






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. Cheekbone






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






5. represents Exemption from the use of modifier -51






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






7. 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.






8. 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






9. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






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






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






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






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






14. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.






15. Are conditions - situations - and services not covered by the insurance carrier.






16. 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






17. This is not specified as benign or malignant in the diagnosis or medical record.






18. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called






19. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






20. 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






21. The cuticle at the lower part of the nail and this is sometimes referred to as the






22. 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.






23. 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






24. 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






25. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.






26. 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






27. 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






28. 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






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






30. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






31. 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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32. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






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






34. 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.






35. 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:






36. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






37. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






38. numbers 8-10 - are attached to the sternum by cartilage






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






40. Poisoning cannot be determined whether intentional or accidental.






41. Noninvasive - non-spreading - nonmalignant






42. 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






43. Is an electronic or paper-based report of payment sent by the payer to the provider.






44. 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'.






45. Superior and widest bone






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






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






48. Upper jaw bone






49. 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






50. 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....