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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. Discolored - flat lesion (freckles - tattoo marks)






2. Noninvasive - non-spreading - nonmalignant






3. 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






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






5. Noninvasive - non-spreading - nonmalignant






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






8. 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






9. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.






10. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






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






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






13. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.

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14. 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






15. 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






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






17. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ






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






19. 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






20. Cheekbone






21. the bone is broken and the ends are driven into each other.






22. 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






23. 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.






24. 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.






25. 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






26. 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






27. 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






28. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..






29. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.






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






31. 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






32. 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.






33. 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






34. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






35. Small collection of clear fluid;blister






36. 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.






37. 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).






38. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






39. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






40. 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






41. 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.






42. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






43. 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.






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






45. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.






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






47. 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.






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






49. cancer that is localized and has not spread to adjacent tissues or distant parts of the body






50. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services