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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. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari






2. This is not specified as benign or malignant in the diagnosis or medical record.






3. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.






4. The poisoning was self-inflicted.






5. Noninvasive - non-spreading - nonmalignant






6. Poisoning cannot be determined whether intentional or accidental.






7. 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....






8. 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.






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






10. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w






11. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.






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






13. Indicates add-on codes






14. 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 -






15. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






16. open sore on the skin or mucous






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






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






20. death of tissue associated with loss of blood supply






21. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.






22. 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.






23. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






24. 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.






25. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






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






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






28. represents Exemption from the use of modifier -51






29. 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.






30. major skin pigment






31. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






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. Consists of the skull - rib cage - and spine






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






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






36. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






37. 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....






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






39. 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).






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






41. 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






42. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






43. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..






44. Number assigned to the physician by Medicare program.






45. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






46. 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.






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






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






49. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime






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