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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. Law passed by the federal government to prosecute cases of Medicaid fraud.






2. The moon like white area at the base of the nail.






3. 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.






4. Is the upper arm bone.






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






6. Typically not used on the claim form unless the provider does not have an EIN.






7. male of household is primary payer






8. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari






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






10. 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






11. Deficient in pigment (melanin)






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






13. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.






14. Forms the sides of the cranium






15. 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






16. 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.






17. 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'.






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






19. 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






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






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






22. forms the roof of the nasal cavity.






23. death of tissue associated with loss of blood supply






24. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -






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






26. 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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27. This modifier is used when the same procedure is performed on a mirror-image part of the body..






28. 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.






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






30. represents Exemption from the use of modifier -51






31. uncertain whether benign or malignant; borderline malignancy






32. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt






33. Cheekbone






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






35. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






36. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.






37. 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






38. 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.






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






40. A fat cell






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






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






43. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission






44. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






45. 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.






46. 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.






47. 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.






48. 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.






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






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