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| Section | Weight | Objectives |
|---|---|---|
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Anatomy and physiology for billers - Healthcare documentation principles - Medical terminology basics |
| CPT Coding | 20-25% | - CPT code categories and structure - Modifiers and their appropriate use - Category II and III codes - Evaluation and Management (E/M) codes - Surgical procedure codes |
| Practice Management | 10-15% | - Collections and payment posting - Accounts receivable management - Patient responsibility calculations - Insurance verification processes - Patient registration and demographics |
| Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Coordination of benefits - Fee schedules and reimbursement methodologies - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing |
| ICD-10-CM Diagnosis Coding | 15-20% | - ICD-10-CM structure and conventions - Code accuracy and specificity - Principal diagnosis selection - Chapter-specific guidelines - Secondary diagnosis coding |
| Billing Compliance and Regulations | 10-15% | - Documentation compliance - Appeal and denial management - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Fraud, waste, and abuse prevention |
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NEW QUESTION # 194
BCBSA stands for Blue Cross Blue Shield Association.
Answer: A
NEW QUESTION # 195
COBRA
Answer: A
NEW QUESTION # 196
Beneficiary counseling and assistance coordinator (BCAC) is individual available at military treatment facility (MTF) to answer questions, help solve healthcare related problems, and assist beneficiaries in obtaining medical care through TRICARE; was previously called health benefits advisor (HBA).
Answer: A
NEW QUESTION # 197
Which payer typically requires prior authorization for certain services?
Answer: D
Explanation:
Commercial and managed care plans frequently require prior authorization.
NEW QUESTION # 198
CMS1500
Answer: C
NEW QUESTION # 199
......
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