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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. 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.






2. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran






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






4. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h






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






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






7. A fracture of the epiphyseal plate in children.






8. 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.






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






10. 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.






11. 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.






12. Structural protein found in the skin and connective tissue






13. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






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






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






16. 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).






17. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






18. 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






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






20. 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






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






22. 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






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






24. 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.






25. make up part of the roof of the mouth






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






27. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






28. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






29. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






30. Deficient in pigment (melanin)






31. Mild or controlled hypertension and no damage to the vascular system or organs.






32. Upper jaw bone






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






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






35. 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






36. 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






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






38. - 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






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






40. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






41. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.






42. 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.






43. 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.






44. 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.






45. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






46. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....






47. Groove or crack like sore






48. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






49. 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.






50. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas