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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
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  • 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. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






2. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






3. Produce secretions that allow the body to be moisturized or cooled.






4. 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






5. 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






6. 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.






7. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






8. Small collection of clear fluid;blister






9. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






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






11. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






12. Absence of hair from areas where it normally grows






13. Medicaid is the payer of last resort. If the patient has Medicare and Medicaid - Medicaid usually pays for the Medicare Part B deductible - coinsurance - and monthly premium amounts. Some of the services covered by Medicaid include the following: Inp






14. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






15. 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






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






17. 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.






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






19. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






20. Consists of the skull - rib cage - and spine






21. Represents a new procedure or service code added since the previous edition of the manual.






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






23. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






24. 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






25. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






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






27. Deficient in pigment (melanin)






28. Forms the sides of the cranium






29. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b






30. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






31. uncertain whether benign or malignant; borderline malignancy






32. Poisoning cannot be determined whether intentional or accidental.






33. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






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






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






36. Is a working diagnosis which is not yet established.






37. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






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






39. 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






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






41. Is the upper arm bone.






42. 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.






43. 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






44. the bone is crushed and or shattered.






45. Is an electronic or paper-based report of payment sent by the payer to the provider.






46. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






47. Upper jaw bone






48. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






49. The bone is broken and pierces an internal organ






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







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