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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. 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.






2. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






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






4. Upper jaw bone






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. 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.






7.






8. 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






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






10. 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






11. .. lower jaw bone.






12. 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






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






14. 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.






15. poisoning was inflicted by another person with intent to kill or injure






16. major skin pigment






17. .. lower jaw bone.






18. Is the lower medial arm bone.






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






20. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.






21. 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






22. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from






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






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






25. 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






26. 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






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






28. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






29. is defined as one who has not received any medical services within the last three years.






30. 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.






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






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






33. 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






34. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.






35. 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






36. forms the roof of the nasal cavity.






37. forms the two lower sides of the cranium.






38. 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.






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






40. 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.






41. Deficient in pigment (melanin)






42. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.






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






44. Small collection of clear fluid;blister






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






46. Absence of hair from areas where it normally grows






47. 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






48. 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.






49. 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






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