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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Coordination of benefits - Commercial insurance policies - Claims submission and processing - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing |
| Topic 2: Practice Management | 10-15% | - Collections and payment posting - Patient responsibility calculations - Patient registration and demographics - Accounts receivable management - Insurance verification processes |
| Topic 3: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Anatomy and physiology for billers - Medical terminology basics |
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Chapter-specific guidelines - ICD-10-CM structure and conventions - Principal diagnosis selection - Code accuracy and specificity |
| Topic 5: CPT Coding | 20-25% | - Surgical procedure codes - Evaluation and Management (E/M) codes - Category II and III codes - CPT code categories and structure - Modifiers and their appropriate use |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Documentation compliance - Appeal and denial management - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics |
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NEW QUESTION # 96
CMP
Answer: D
NEW QUESTION # 97
BlueCard Program is program that allows BCBS subscribers to receive local Blue Plan healthcare benefits while traveling or living outside of their plan's area.
Answer: A
NEW QUESTION # 98
Which payer typically requires prior authorization for certain services?
Answer: B
Explanation:
Commercial and managed care plans frequently require prior authorization.
NEW QUESTION # 99
What does AHA stand for?
Answer: B
NEW QUESTION # 100
FEHBP stands for Federal Employee Health Benefit Program.
Answer: A
NEW QUESTION # 101
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