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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 Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual






2. requires investigation and needs further clarification.






3. Indicates add-on codes






4. 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






5. the bone is crushed and or shattered.






6. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t






7. 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.






8. 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






9. 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






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






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






12. 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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13. anterior to the temporal bones.






14. A fat cell






15. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






16. 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.






17. 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






18. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






19. 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.






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






21. 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






22. 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.






23. This is the inventory of the constitutional symptoms regarding the various body systems.






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






25. 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.






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






27. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.






28. The moon like white area at the base of the nail.






29. 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






30. Deficient in pigment (melanin)






31. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






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






33. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






34. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






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






36. The fractured area of bone collapses on itself.






37. Cheekbone






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






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






40. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).






41. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.






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






43. 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.






44. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






45. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on






46. Represent changes in the text or definition between the triangles.






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






48. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.






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






50. Small collection of clear fluid;blister