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. 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






2. Are conditions - situations - and services not covered by the insurance carrier.






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






4. 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....






5. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin






6. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.






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






8. The bone is broken and pierces an internal organ






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






10. cancer that is localized and has not spread to adjacent tissues or distant parts of the body






11. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.






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






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. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






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






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






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






18. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






19. 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






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






21. Medicare Managed Care Plans (Formerly Medicare Plus (+) Choice Plan) was created to offer a number of healthcare services in addition to those available under Part A and Part B. The CMS contracts with managed care plans or provider service organizati






22. 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






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






24. 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.






25. 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.'






26. 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






27. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules






28. 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 -






29. 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






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






31. 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






32. Pre-determined set of benefits covered under one set annual fee.






33. 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






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






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






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






37. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






38. 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






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






40. Typically not used on the claim form unless the provider does not have an EIN.






41. Number assigned to the physician by Medicare program.






42. The moon like white area at the base of the nail.






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






44. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






45. 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






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






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






48. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.






49. The poisoning was self-inflicted.






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