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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. Lower portion of the pelvic bone






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






3. Forms the sides of the cranium






4. The bone is broken and pierces an internal organ






5. Is the lateral lower arm bone (in line with the thumb).






6. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






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






8. 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






9. 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






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






11. 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.






12. 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






13. Groove or crack like sore






14. anterior to the temporal bones.






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






16. 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






17. Is the lateral lower arm bone (in line with the thumb).






18. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






19. Is a working diagnosis which is not yet established.






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






21. Produce secretions that allow the body to be moisturized or cooled.






22. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.






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






24. 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.






25. anterior to the temporal bones.






26. Contains complete - necessary information - but is incorrect or illogical in some way.






27. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U






28. means the provider agrees to accept what the insurance company approves as payment in full for the claim.






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






30. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






31. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w






32. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.






33. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






34. Most billing-related cases are based on HIPAA and False Claims Act.






35. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






36. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features






37. 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






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






39. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth






40. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






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






42. 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.






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






44. 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






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






46. 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






47. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....






48. Indicates add-on codes






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






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