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| Section | Weight | Objectives |
|---|---|---|
| Insurance and Reimbursement | 20-25% | - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Claims submission and processing |
| Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles - Revenue cycle overview |
| Billing Compliance and Regulations | 10-15% | - Documentation compliance - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements - Appeal and denial management |
| CPT Coding | 20-25% | - Category II and III codes - Evaluation and Management (E/M) codes - Surgical procedure codes - Modifiers and their appropriate use - CPT code categories and structure |
| ICD-10-CM Diagnosis Coding | 15-20% | - Chapter-specific guidelines - Principal diagnosis selection - ICD-10-CM structure and conventions - Code accuracy and specificity - Secondary diagnosis coding |
| Practice Management | 10-15% | - Insurance verification processes - Patient registration and demographics - Accounts receivable management - Patient responsibility calculations - Collections and payment posting |
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NEW QUESTION # 215
What does it mean by itis?
Answer: D
NEW QUESTION # 216
The medical word root "hyster" or "hyster/o" refers to the:
Answer: C
NEW QUESTION # 217
What does it mean by gluc and glyc?
Answer: B
NEW QUESTION # 218
Adverse Selection includes covering members who are sicker then the general population.
Answer: A
NEW QUESTION # 219
Care plan oversight services cover the physician's time supervising a complex and multidisciplinary care treatment program for specific patient who is under the care of a home health agency, hospice, or nursing facility.
Answer: A
NEW QUESTION # 220
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