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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. Any fracture occurring spontaneously as a result of disease.






2. 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.






3. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






4. 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






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






6. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






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






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






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






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






11. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.






12. Number assigned to the physician by Medicare program.






13. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






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






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






16. Noninvasive - non-spreading - nonmalignant






17. 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.






18. 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.






19. - 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






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






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. 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






23. The poisoning was self-inflicted.






24. 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






25. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






26. represents Exemption from the use of modifier -51






27. 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






28. represents Exemption from the use of modifier -51






29. Is the qualifying factor or factors that must be met before a patient receives benefits.






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






31. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






32. 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






33. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






34. 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






35. Law passed by the federal government to prosecute cases of Medicaid fraud.






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






37. Forms the sides of the cranium






38. Indicates add-on codes






39. 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.






40. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.






41. Noninvasive - non-spreading - nonmalignant






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






43.






44. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






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






46. Indicates add-on codes






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






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






49.






50. Small collection of clear fluid;blister