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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Coordination of benefits - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing - Commercial insurance policies |
| Topic 2: CPT Coding | 20-25% | - Modifiers and their appropriate use - CPT code categories and structure - Surgical procedure codes - Category II and III codes - Evaluation and Management (E/M) codes |
| Topic 3: Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Documentation compliance - Fraud, waste, and abuse prevention - Appeal and denial management - Stark Law and Anti-Kickback Statute basics |
| Topic 4: Practice Management | 10-15% | - Collections and payment posting - Patient registration and demographics - Patient responsibility calculations - Insurance verification processes - Accounts receivable management |
| Topic 5: Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Healthcare documentation principles - Revenue cycle overview - Anatomy and physiology for billers |
| Topic 6: ICD-10-CM Diagnosis Coding | 15-20% | - ICD-10-CM structure and conventions - Code accuracy and specificity - Chapter-specific guidelines - Principal diagnosis selection - Secondary diagnosis coding |
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NEW QUESTION # 91
Which scenario would most likely result in a claim denial for lack of medical necessity?
Answer: B
Explanation:
Medical necessity denials occur when the diagnosis does not justify the billed service.
NEW QUESTION # 92
When is an Advance Beneficiary Notice (ABN) required?
Answer: B
Explanation:
An ABN informs Medicare patients that they may be financially responsible if coverage is denied.
NEW QUESTION # 93
What does it mean by intra and intro?
Answer: B
NEW QUESTION # 94
The medical prefixes "a-" and "an-" mean:
Answer: D
NEW QUESTION # 95
CRI
Answer: B
NEW QUESTION # 96
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