Test your basic knowledge |

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






2. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






3. 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






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






5. poisoning was inflicted by another person with intent to kill or injure






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






7. male of household is primary payer






8. 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.






9. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






10. 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 -






11. 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






12. is defined as one who has not received any medical services within the last three years.






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






14. 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






15. 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:






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






17. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






18. Is the lower medial arm bone.






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






20. 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






21. 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






22. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






23. The fractured area of bone collapses on itself.






24. 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






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






26. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -






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






28. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






29. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).






30. Deficient in pigment (melanin)






31. 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






32. anterior to the temporal bones.






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






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






35. 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.






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






37. The bone is broken and pierces an internal organ






38. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p






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






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






41. uncertain whether benign or malignant; borderline malignancy






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






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






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






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






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






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






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






49. 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






50. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.