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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
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  • Match each statement with the correct term.
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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. 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.






2. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin






3. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






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






5. 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.






6. 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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7. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must






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






9. Groove or crack like sore






10. 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






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






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






13. Noninvasive - non-spreading - nonmalignant






14. 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.






15. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






16. 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






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






18. The fractured area of bone collapses on itself.






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






20. Upper jaw bone






21. 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.






22. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






23. 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






24. Make up part of the interior of the nose.






25. 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.






26. Upper jaw bone






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






28. Deficient in pigment (melanin)






29. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.






30. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.






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






32. 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.






33. 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.






34. 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






35. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






36. 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






37. Poisoning cannot be determined whether intentional or accidental.






38. cancer that is localized and has not spread to adjacent tissues or distant parts of the body






39. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






40. Superior and widest bone






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






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






43. 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






44. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation






45. The fractured area of bone collapses on itself.






46. 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






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






48. 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






49. 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.






50. Is the upper arm bone.







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