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. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






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






3.






4. 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..






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






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






7. 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






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






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






10. 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.






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






12. 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






13. 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






14. represents Exemption from the use of modifier -51






15. 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






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






17. 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






18. This modifier is used when the same procedure is performed on a mirror-image part of the body..






19. 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






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






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






22. 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.






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






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






25. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






26. 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






27. Make up part of the interior of the nose.






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






29. 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






30. 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






31. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.






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






33. - 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






34. Forms the sides of the cranium






35. 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.






36. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.






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






38. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






39. 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






40. 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.






41. 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






42. 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






43. the bone is crushed and or shattered.






44. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






45. numbers 8-10 - are attached to the sternum by cartilage






46. The main term in the index may by followed by terms within parenthesis.






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






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






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






50. Forms the anterior part of the skull and the forehead