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Medical Billing And Coding Vocab

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

2. represents Exemption from the use of modifier -51

3. 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

4. represents Exemption from the use of modifier -51

5. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients

6. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:

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

8. 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

9. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.

10. 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.

11. A fat cell

12. 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.

13. Are composed of three-digit codes representing a single disease or condition.

14. 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.

15. 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

16. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.

17. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.

18. 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.

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


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

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

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

24. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features

25. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.

26. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord

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

28. 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.

29. Is the lower medial arm bone.

30. Absence of hair from areas where it normally grows

31. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.

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

33. 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

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. 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

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

37. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.

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

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

40. The lower anterior part of the bone

41. 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

42. Cheekbone

43. Is the upper arm bone.

44. Is the lateral lower arm bone (in line with the thumb).

45. 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.

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

47. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari

48. This is the inventory of the constitutional symptoms regarding the various body systems.

49. 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.

50. are small with irregular shapes. They are found in the wrist and ankle.