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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. Upper jaw bone






2. 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.






3. Noninvasive - non-spreading - nonmalignant






4. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re






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






6. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.






7. 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






8. 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 -






9. 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.






10. death of tissue associated with loss of blood supply






11. forms the two lower sides of the cranium.






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






13. 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.






14. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin






15. A fat cell






16. 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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17. The bone is broken and pierces an internal organ






18. 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.






19. 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






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






21. Poisoning cannot be determined whether intentional or accidental.






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






23. 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.






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






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






26. 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






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. 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.






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






30. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features






31. make up part of the roof of the mouth






32. forms the roof of the nasal cavity.






33. 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.






34. The lower anterior part of the bone






35. The fractured area of bone collapses on itself.






36. 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.






37. Number assigned to the physician by Medicare program.






38. forms the two lower sides of the cranium.






39. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






40. 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






41. 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.






42. Forms the sides of the cranium






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






44. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.






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






46. 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






47. Is the lower medial arm bone.






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






49. 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






50. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.