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






2. make up part of the roof of the mouth






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






4. 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.






5. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p






6. 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






7. 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






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






9. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.






10. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.






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






12. Number assigned to the physician by Medicare program.






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






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






15. Typically not used on the claim form unless the provider does not have an EIN.






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






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






18. 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.






19. 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.






20. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






21. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






22. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






23. 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.






24. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






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






26. Cheekbone






27. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






28. 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.






29. Is the lower medial arm bone.






30. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






31. 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.






32. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called






33. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






34. 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






35. 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.






36. The physician must obtain this number in order to practice within a state.






37. 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....






38. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






39. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.






40. This is a set of information the physician gathers from the patient regarding the following:






41. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






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






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






44. 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






45. 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






46. 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'.






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






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






49. 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'.






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