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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. is basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options






2. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






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






4. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.

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






6. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on






7. Noninvasive - non-spreading - nonmalignant






8. 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.






9. make up part of the roof of the mouth






10. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health






11. 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






12. 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.






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






14. numbers 8-10 - are attached to the sternum by cartilage






15. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ






16. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






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






18. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.






19. 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






20. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay






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






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






23. The lower anterior part of the bone






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






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






26. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t






27. major skin pigment






28. represents Exemption from the use of modifier -51






29. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






30. 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.






31. uncertain whether benign or malignant; borderline malignancy






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






33. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.






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






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






36. Absence of hair from areas where it normally grows






37. solid - round or oval elevated lesion more than 1 cm in diameter






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






39. is a traumatic injury to a joint involving the soft tissue.






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






41. anterior to the temporal bones.






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






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






44. 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






45. poisoning was inflicted by another person with intent to kill or injure






46. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.






47. The reason the patient came to see the physician.






48. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






49. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.






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