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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. 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.






2. solid - round or oval elevated lesion more than 1 cm in diameter






3. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






4. 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






5. 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.






6. 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).






7. Structural protein found in the skin and connective tissue






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






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






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






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. 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.






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






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






15. The lower anterior part of the bone






16. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






17. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay






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






19. Pre-determined set of benefits covered under one set annual fee.






20. the bone is crushed and or shattered.






21. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






22. 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.






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






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






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






26. 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






27. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....






28. 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.






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






30. The bone is broken and pierces an internal organ






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






32. The lower anterior part of the bone






33. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






34. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.

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35. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






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






37. Groove or crack like sore






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






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






40. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






41. forms the roof of the nasal cavity.






42. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U






43. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






44. 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






45. 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.






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






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






48. 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






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






50. 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






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