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






2. The reason the patient came to see the physician.






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






4. 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.






5. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






6. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.






7. 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.






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






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






11. 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






12. 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






13. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service






14. 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






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






16. 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






17. 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






18. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






19. 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






20. is a traumatic injury to a joint involving the soft tissue.






21. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






22. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






23. 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.






24. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






25. A fat cell






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






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






28. 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.






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






30. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the






31. Is the lateral lower arm bone (in line with the thumb).






32. are small with irregular shapes. They are found in the wrist and ankle.






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






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






35. 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.






36. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






37. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






38. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






39. 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.






40. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






41. 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






42. The bone is broken and pierces an internal organ






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






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






45. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






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






47. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






48. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






49. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






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







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