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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Revenue cycle overview - Medical terminology basics - Healthcare documentation principles |
| Topic 2: Insurance and Reimbursement | 20-25% | - Coordination of benefits - Fee schedules and reimbursement methodologies - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Claims submission and processing - Commercial insurance policies |
| Topic 3: 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 4: ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Chapter-specific guidelines - Code accuracy and specificity - Principal diagnosis selection - ICD-10-CM structure and conventions |
| Topic 5: Practice Management | 10-15% | - Insurance verification processes - Collections and payment posting - Accounts receivable management - Patient responsibility calculations - Patient registration and demographics |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Stark Law and Anti-Kickback Statute basics - Documentation compliance - Fraud, waste, and abuse prevention - HIPAA privacy and security requirements |
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NEW QUESTION # 161
Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?
Answer: B
NEW QUESTION # 162
Accounts Receivable Aging Report
Answer: B
NEW QUESTION # 163
Blue Cross Blue Shield (BCBS) is joint venture between Blue Cross and Blue Shield where the corporation shared one building and computer.
Answer: A
NEW QUESTION # 164
What does it mean by cry?
Answer: A
NEW QUESTION # 165
CLIA
Answer: A
NEW QUESTION # 166
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