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. This is a set of information the physician gathers from the patient regarding the following:






2. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on






3. Discolored - flat lesion (freckles - tattoo marks)






4. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






5. 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.






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






7. 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






8. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from






9. 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






10. 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).






11. 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






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






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






14. 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






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






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






17. .. lower jaw bone.






18. 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






19. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






20. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






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






22. most synarthroses are immovable joints held together by fibrous tissue.






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






24. 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.






25. Structural protein found in the skin and connective tissue






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






27. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






28. Groove or crack like sore






29. Discolored - flat lesion (freckles - tattoo marks)






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






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






32. anterior to the temporal bones.






33. 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






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






35. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






36. 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






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. death of tissue associated with loss of blood supply






39. 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.






40. 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....






41. The lower anterior part of the bone






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






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






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






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.






47. the bone is broken and the ends are driven into each other.






48. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..






49. 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.






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