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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. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati






2. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






3. 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.






4. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






5. 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.






6. 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.






7. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.






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






9. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






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






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






12. 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'.






13. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation






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






15. 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.






16. 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






17. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from






18. 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.






19. - 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.






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






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






22. solid - round or oval elevated lesion more than 1 cm in diameter






23. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.






24. Superior and widest bone






25. The poisoning was self-inflicted.






26. 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).






27. Number assigned to the physician by Medicare program.






28. Small collection of clear fluid;blister






29. Indicates add-on codes






30. 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






31. Contains complete - necessary information - but is incorrect or illogical in some way.






32. represents Exemption from the use of modifier -51






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






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






35. 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.






36. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.






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






38. 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






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






40. 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.






41. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






42. paired bones at the corner of each eye that cradle the tear ducts.






43. 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.






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






45. 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.






46. Groove or crack like sore






47. Is the lower medial arm bone.






48. Mild or controlled hypertension and no damage to the vascular system or organs.






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






50. Represents a new procedure or service code added since the previous edition of the manual.