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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - Code accuracy and specificity - Chapter-specific guidelines - Secondary diagnosis coding - ICD-10-CM structure and conventions |
| Topic 2: Insurance and Reimbursement | 20-25% | - Fee schedules and reimbursement methodologies - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Commercial insurance policies - Claims submission and processing |
| Topic 3: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Healthcare documentation principles - Anatomy and physiology for billers |
| Topic 4: Practice Management | 10-15% | - Patient responsibility calculations - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Accounts receivable management |
| Topic 5: CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - CPT code categories and structure - Category II and III codes - Modifiers and their appropriate use - Surgical procedure codes |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Stark Law and Anti-Kickback Statute basics - Documentation compliance - HIPAA privacy and security requirements - Appeal and denial management - Fraud, waste, and abuse prevention |
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NEW QUESTION # 122
What does "timely filing" refer to?
Answer: B
Explanation:
Timely filing means submitting claims within the time limits set by the payer.
NEW QUESTION # 123
What does it mean by graph?
Answer: A
NEW QUESTION # 124
Billing entity is the legal business name of the provider's practice.
Answer: A
NEW QUESTION # 125
What is accreditation?
Answer: B
NEW QUESTION # 126
Benefit period (Medicare) __________
Answer: D
NEW QUESTION # 127
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