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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. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the






2. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.






3. Groove or crack like sore






4. 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.






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






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






7. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.






8. Absence of hair from areas where it normally grows






9. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances






10. make up part of the roof of the mouth






11. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






12. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






13. most synarthroses are immovable joints held together by fibrous tissue.






14. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






15. 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.






16. Deficient in pigment (melanin)






17. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






18. 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.






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. 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'.






21. 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






22. Upper jaw bone






23. male of household is primary payer






24. 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






25. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ






26. 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






27. represents Exemption from the use of modifier -51






28. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






29. Is the upper arm bone.






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






31. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






32. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt






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






34. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






35. 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.






36. the bone is broken and the ends are driven into each other.






37. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






38. most synarthroses are immovable joints held together by fibrous tissue.






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






40. Small collection of clear fluid;blister






41.






42. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord






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






44. 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






45. major skin pigment






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






47. 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.






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






49. Forms the sides of the cranium






50. This modifier is used when the same procedure is performed on a mirror-image part of the body..