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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. 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






2. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from






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






4. Number assigned to the physician by Medicare program.






5. Small collection of clear fluid;blister






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






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






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






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






10. 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






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






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






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






14. 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.






15. 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.






16. 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....






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






18. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






19. 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).






20. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






21. 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.






22. represents Exemption from the use of modifier -51






23. 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






24. the bone is crushed and or shattered.






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






26. 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.






27. Is one who has no contract with the health insurance plan.






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






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






30. Upper jaw bone






31. Groove or crack like sore






32. 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 -






33. Superior and widest bone






34. 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






35. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






36. 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






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






38. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.






39. 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.






40. Upper jaw bone






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






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






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






44. Forms the anterior part of the skull and the forehead






45. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services






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






47. Is the upper arm bone.






48. Is one who has no contract with the health insurance plan.






49. .. lower jaw bone.






50. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance