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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Coordination of benefits - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing - Commercial insurance policies - Claims submission and processing |
| Topic 2: ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - ICD-10-CM structure and conventions - Secondary diagnosis coding - Chapter-specific guidelines - Code accuracy and specificity |
| Topic 3: Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Medical terminology basics - Revenue cycle overview - Healthcare documentation principles |
| Topic 4: CPT Coding | 20-25% | - Surgical procedure codes - Modifiers and their appropriate use - Category II and III codes - Evaluation and Management (E/M) codes - CPT code categories and structure |
| Topic 5: Practice Management | 10-15% | - Accounts receivable management - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Patient responsibility calculations |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Appeal and denial management - Documentation compliance - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics |
1. Which entity is responsible for enforcing HIPAA privacy regulations?
A) Office for Civil Rights (OCR)
B) CMS
C) American Medical Association (AMA)
D) Office of Inspector General (OIG)
2. abdomin
A) abdomen
B) extremities, top
C) toward
3. What does GEM stand for?
A) Group Enrollment Management
B) General Enrollment Management
C) Geographic Equivalency Mapping
D) General Equivalency Mapping
4. extra
A) milk
B) fiber
C) outside
D) before
5. FEHBP stands for Federal Employee Health Benefit Program.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: D | Question # 4 Answer: C | Question # 5 Answer: A |
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