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






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






3. 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






4. 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






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






6. 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....






7. The fractured area of bone collapses on itself.






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






9. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






10. 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






11. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






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






13. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re






14. Is when two insurance companies work together to coordinate payment of the benefits.






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






16. 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






17. 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.






18. The cuticle at the lower part of the nail and this is sometimes referred to as the






19. Poisoning cannot be determined whether intentional or accidental.






20. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






21. 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






22. major skin pigment






23. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






24. 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






25. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






26. 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






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






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






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






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






31. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






32. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben






33. 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.






34. 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






35. 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






36. Discolored - flat lesion (freckles - tattoo marks)






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






38. 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






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






40. Is the lower medial arm bone.






41. 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).






42. 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.






43. - 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






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






45. Upper jaw bone






46. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






47. 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






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






49. The lower anterior part of the bone






50. Describes the services billed and includes a breakdown of how the payment is determined







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