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






2. 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.






3. 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.






4. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo






5. The fractured area of bone collapses on itself.






6. 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






7. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.






8. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






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






10. Is the lower medial arm bone.






11. Poisoning cannot be determined whether intentional or accidental.






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






13. 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






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






15. most synarthroses are immovable joints held together by fibrous tissue.






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






17. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






18. Make up part of the interior of the nose.






19. 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.






20. 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






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






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






23. 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






24. 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






25. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






26. Deficient in pigment (melanin)






27. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.






28. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas






29. Is the upper arm bone.






30. Forms the sides of the cranium






31. 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






32. 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.






33. 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






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






35. Is the lower medial arm bone.






36. Noninvasive - non-spreading - nonmalignant






37. 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:






38. 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






39. forms the two lower sides of the cranium.






40. Groove or crack like sore






41. 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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42. 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






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






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






45. The bone is broken and pierces an internal organ






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






47. 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






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






49. 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.






50. The physician must obtain this number in order to practice within a state.