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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. 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






2. forms the roof of the nasal cavity.






3. 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.






4. 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.






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






6. Consists of the skull - rib cage - and spine






7. 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.






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






9. 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






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






11. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






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






13. requires investigation and needs further clarification.






14. 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..






15. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






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






17. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






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






19. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.






20. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules






21. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






22. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






23. 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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24. 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






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






26. Is one who has no contract with the health insurance plan.






27. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben






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






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






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






31. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options






32. 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






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






34. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.






35. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






36. 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






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






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






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. Discolored - flat lesion (freckles - tattoo marks)






41. 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






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. 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






44. 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.






45. 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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46. - 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.






47. 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






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






49. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






50. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.