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






2. Indicates add-on codes






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






4. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.






5. 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






6. Are conditions - situations - and services not covered by the insurance carrier.






7. 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






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






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






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






11. male of household is primary payer






12. forms the two lower sides of the cranium.






13. Lower portion of the pelvic bone






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






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






16. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






17. Structural protein found in the skin and connective tissue






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






19. 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






20. 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






21. death of tissue associated with loss of blood supply






22. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.






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






24. 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....






25. 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.






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






27. 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






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






29. anterior to the temporal bones.






30. 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.






31. - 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.






32. Any fracture occurring spontaneously as a result of disease.






33. Is the upper arm bone.






34. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






35. 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.






36. 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






37. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers






38. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






39. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






40. 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






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






42. The cuticle at the lower part of the nail and this is sometimes referred to as the






43. 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






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






46. 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






47. .. lower jaw bone.






48. 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






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






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