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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. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.






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






3. Forms the sides of the cranium






4. 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






5. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.






6. major skin pigment






7. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U






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






9. 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






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






11. - 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






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






13. 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.






14. 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.






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






16. 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.






17. 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






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






19. 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






20. 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.






21. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






22. means the provider agrees to accept what the insurance company approves as payment in full for the claim.






23. 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






24. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






25. 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






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






27. 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.






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






29. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....






30. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w






31. 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






32. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an






33. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






34. Is made up of the shoulder - collar - pelvic and arms and legs






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






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






37. 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






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






39. represents Exemption from the use of modifier -51






40. 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






41. 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.






42. Superior and widest bone






43. A pregnant woman who has had at least one previous pregnancy.






44. 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.






45. 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






46. Further classified as to primary - secondary - or carcinoma in situ.






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






48. - 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.






49. 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....






50. 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