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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. 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.






2. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






3. 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






4. 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






5. Is the upper arm bone.






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






7. 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






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






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






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






11. Benign growth extending from the surface of the mucous membrane






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






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






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






15. The reason the patient came to see the physician.






16. 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






17. forms the two lower sides of the cranium.






18. Small collection of clear fluid;blister






19. 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.






20. 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






21. 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.






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






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






24. 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.






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






26. Absence of hair from areas where it normally grows






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






28. Structural protein found in the skin and connective tissue






29. Law passed by the federal government to prosecute cases of Medicaid fraud.






30. open sore on the skin or mucous






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






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






34. 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






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






36. Noninvasive - non-spreading - nonmalignant






37. .. lower jaw bone.






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






39. Is the lower medial arm bone.






40. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






41. 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'.






42. 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






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






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






45. 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






46. Further classified as to primary - secondary - or carcinoma in situ.






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. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h






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






50. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).