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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Medical terminology basics - Revenue cycle overview - Healthcare documentation principles |
| Topic 2: Practice Management | 10-15% | - Insurance verification processes - Accounts receivable management - Patient responsibility calculations - Collections and payment posting - Patient registration and demographics |
| Topic 3: ICD-10-CM Diagnosis Coding | 15-20% | - ICD-10-CM structure and conventions - Principal diagnosis selection - Secondary diagnosis coding - Code accuracy and specificity - Chapter-specific guidelines |
| Topic 4: CPT Coding | 20-25% | - Surgical procedure codes - CPT code categories and structure - Modifiers and their appropriate use - Evaluation and Management (E/M) codes - Category II and III codes |
| Topic 5: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies - Coordination of benefits - Commercial insurance policies |
| Topic 6: Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Documentation compliance - Appeal and denial management - Stark Law and Anti-Kickback Statute basics |
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NEW QUESTION # 228
Which factor determines the correct payer sequence in coordination of benefits (COB)?
Answer: D
Explanation:
The birthday rule is used for dependents to determine primary coverage.
NEW QUESTION # 229
FMAP stands for Federal Medical Assistance Percentage.
Answer: B
NEW QUESTION # 230
The medical prefix "dys-" means:
Answer: D
NEW QUESTION # 231
GCPI stands for Geographic Cost Practice Index.
Answer: B
NEW QUESTION # 232
What does it mean by adip?
Answer: B
NEW QUESTION # 233
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