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






2. 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






3. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






4. is a traumatic injury to a joint involving the soft tissue.






5. represents Exemption from the use of modifier -51






6. 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.






7. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






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






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






11. 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






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






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






14. 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.






15. 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.






16. 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:






17. 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






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






19. is a traumatic injury to a joint involving the soft tissue.






20. The fractured area of bone collapses on itself.






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






22. - 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.






23. Forms the sides of the cranium






24. 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.






25.






26. 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






27. 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






28. 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






29. 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.






30. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances






31. The fractured area of bone collapses on itself.






32. 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.






33. A fat cell






34. 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






35. 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






36. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






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






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






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






40. 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.






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






42. 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....






43. are small with irregular shapes. They are found in the wrist and ankle.






44. 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






45. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.






46. 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.






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






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






49. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






50. 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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