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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. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






2. forms the roof of the nasal cavity.






3. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers






4. 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.






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






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






7. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.






8. 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....






9. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






10. 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






11. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






12. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.






13. .. lower jaw bone.






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






15. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






16. 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.






17. 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.






18. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






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






20. 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.






21. Structural protein found in the skin and connective tissue






22. 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






23. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






24. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






25. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances






26. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






27. 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.






28. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






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






30. - 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






31. 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






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






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






34. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.






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






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






37. 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






38. Absence of hair from areas where it normally grows






39. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h






40. '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






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






42. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.






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






44. 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:






45.






46. major skin pigment






47. 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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48. 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






49. Number assigned to the physician by Medicare program.






50. Consists of the skull - rib cage - and spine