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






2. 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






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






4. - 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






5. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.






6. make up part of the roof of the mouth






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






8. 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....






9. 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 -






10. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual






11. 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






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






13. 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.






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






15. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






16. Number assigned to the physician by Medicare program.






17. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






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






19. 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






20. Is one who has no contract with the health insurance plan.






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






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






23. Most billing-related cases are based on HIPAA and False Claims Act.






24. 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)






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






26. 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






27. This is the inventory of the constitutional symptoms regarding the various body systems.






28. Is the upper arm bone.






29. 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.






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






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






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






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






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






35. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






36. Lower portion of the pelvic bone






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






38. death of tissue associated with loss of blood supply






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






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






41. The poisoning was self-inflicted.






42. Indicates add-on codes






43. 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






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






45. 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






46. A fat cell






47. 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.






48. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.






49. 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.






50. 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