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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. Most billing-related cases are based on HIPAA and False Claims Act.






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






3. 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.






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






5. 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






6. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.






7. - 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






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






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






10. The poisoning was self-inflicted.






11. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.






12. Produce secretions that allow the body to be moisturized or cooled.






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






14. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






15. 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.






16. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






17. anterior to the temporal bones.






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






19. Forms the sides of the cranium






20. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






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






22. 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.






23. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime






24. forms the roof of the nasal cavity.






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






26. 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






27. 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.






28. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.






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






30. 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.






31. 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.






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






33. - 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.






34. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






35. paired bones at the corner of each eye that cradle the tear ducts.






36. The cuticle at the lower part of the nail and this is sometimes referred to as the






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






38. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must






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






40. 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.






41. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






42. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






43. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






44. Is the lower medial arm bone.






45. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime






46. 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






47. Structural protein found in the skin and connective tissue






48. Represents a new procedure or service code added since the previous edition of the manual.






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






50. 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.







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