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| Section | Weight | Objectives |
|---|---|---|
| Insurance and Reimbursement | 20-25% | - Workers' compensation and no-fault billing - Coordination of benefits - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Fee schedules and reimbursement methodologies |
| ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Principal diagnosis selection - Chapter-specific guidelines - Secondary diagnosis coding - ICD-10-CM structure and conventions |
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Anatomy and physiology for billers - Medical terminology basics |
| CPT Coding | 20-25% | - Category II and III codes - Evaluation and Management (E/M) codes - Modifiers and their appropriate use - Surgical procedure codes - CPT code categories and structure |
| Practice Management | 10-15% | - Insurance verification processes - Collections and payment posting - Accounts receivable management - Patient responsibility calculations - Patient registration and demographics |
| Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - Documentation compliance |
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NEW QUESTION # 136
What does it mean by ipsi?
Answer: B
NEW QUESTION # 137
What is the main purpose of an audit in medical billing?
Answer: C
Explanation:
Audits are used to verify accurate billing practices and ensure compliance with regulations.
NEW QUESTION # 138
Which of the following suffixes does NOT mean blood?
Answer: C
NEW QUESTION # 139
blephar
Answer: C
NEW QUESTION # 140
Case management services is a process by which an attending physician coordinates and supervises care provided to patient by other providers.
Answer: A
NEW QUESTION # 141
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