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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. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






2. 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






3. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






4. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






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






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






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






8. Indicates add-on codes






9. Upper jaw bone






10. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






11. Groove or crack like sore






12. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






13. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






14. 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






15. 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






16. Structural protein found in the skin and connective tissue






17. 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.






18. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






19. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






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






21. 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 -






22. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.






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






24. Is made up of the shoulder - collar - pelvic and arms and legs






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






26. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






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






28. 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






29. 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.






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






31. 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.






32. represents Exemption from the use of modifier -51






33. 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.






34. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.






35. 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 -






36. 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.






37. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






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






39. Groove or crack like sore






40. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






41. Pre-determined set of benefits covered under one set annual fee.






42. 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






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






44. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.






45. 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






46. Cheekbone






47. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






48. 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.






49. Discolored - flat lesion (freckles - tattoo marks)






50. 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.