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. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






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






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






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






5. - 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.






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






7. Indicates add-on codes






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






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






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






11. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






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






13. - 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






14. Represent changes in the text or definition between the triangles.






15. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.






16. Forms the sides of the cranium






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






18. Contains complete - necessary information - but is incorrect or illogical in some way.






19. 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 -






20. Groove or crack like sore






21. 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....






22. 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....






23. Number assigned by the insurance company to a physician who renders services to patients.






24. 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






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






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






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






28. Noninvasive - non-spreading - nonmalignant






29. 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






30. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






31. 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.'






32. 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






33. The fractured area of bone collapses on itself.






34. The cuticle at the lower part of the nail and this is sometimes referred to as the






35. 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






36. 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 -






37. major skin pigment






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






39. forms the roof of the nasal cavity.






40. Benign growth extending from the surface of the mucous membrane






41. The fractured area of bone collapses on itself.






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






43. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






44. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.






45. Describes the services billed and includes a breakdown of how the payment is determined






46. 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.






47. 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.






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






49. 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






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