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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. Structural protein found in the skin and connective tissue






2. '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






3. Any fracture occurring spontaneously as a result of disease.






4. The main term in the index may by followed by terms within parenthesis.






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






6. 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.






7. death of tissue associated with loss of blood supply






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






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






10. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






11. 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.






12. 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.






13. 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.






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






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






16. 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






17. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.






18. This is any procedure or service reported on the insurance claim that is not listed in the payer's master benefit list. This will result in the denial of the claim. Providers may be able to recover the charges from the patient.






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






20. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






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






22. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






23. Contains complete - necessary information - but is incorrect or illogical in some way.






24. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






25. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






26. 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






27. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






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






29. 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.






30. 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






31. make up part of the roof of the mouth






32. 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






33. 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.






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






35. Number assigned to the physician by Medicare program.






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






37. 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.






38. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






39. Number assigned by the insurance company to a physician who renders services to patients.






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. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.






42. Lower portion of the pelvic bone






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






44. Pre-determined set of benefits covered under one set annual fee.






45. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






46. .. lower jaw bone.






47. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported






48. male of household is primary payer






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






50. is defined as one who has not received any medical services within the last three years.