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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. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






2. 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






3. forms the two lower sides of the cranium.






4. Is a working diagnosis which is not yet established.






5. 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.






6. anterior to the temporal bones.






7. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






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






9. Upper jaw bone






10. Absence of hair from areas where it normally grows






11. The lower anterior part of the bone






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






13. .. lower jaw bone.






14. uncertain whether benign or malignant; borderline malignancy






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






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






17. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






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






19. Numbers 1-7 - attach directly to the sternum in the front of the body.






20. 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






21. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules






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






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






24. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






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






26. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the

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27. 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.






28. This is a set of information the physician gathers from the patient regarding the following:






29. 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






30. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






31. major skin pigment






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






33. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






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






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






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






37. 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






38. 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






39. 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






40. open sore on the skin or mucous






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






42. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati






43. 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).






44. Is an electronic or paper-based report of payment sent by the payer to the provider.






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






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






47. 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.






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






49. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






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