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| Section | Weight | Objectives |
|---|---|---|
| Practice Management | 10-15% | - Accounts receivable management - Patient responsibility calculations - Insurance verification processes - Collections and payment posting - Patient registration and demographics |
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Anatomy and physiology for billers - Medical terminology basics |
| 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 |
| Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Commercial insurance policies - Workers' compensation and no-fault billing - Claims submission and processing - Coordination of benefits |
| Billing Compliance and Regulations | 10-15% | - Appeal and denial management - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - Documentation compliance |
| CPT Coding | 20-25% | - Modifiers and their appropriate use - CPT code categories and structure - Evaluation and Management (E/M) codes - Surgical procedure codes - Category II and III codes |
1. Which is the universal claim form used by physicians offices?
A) Explanation of Benefits
B) Centers of Medicare and Medicaid Services150 (CMS1500)
C) Health Insurance Claim
D) Hold Harmless Clause
2. What does "timely filing" refer to?
A) Submitting claims within payer-specific deadlines
B) Electronic claim submission
C) Same-day billing
D) Submitting claims quickly
3. COBRA
A) Consolidated Omnibus Budget Reconciliation Act of 1985
B) CHAMPUS Reform Initiative
C) Current Procedural Terminology
D) Certified Professional Coder
4. What does it mean by itis?
A) edema
B) infection
C) swelling
D) inflammation
5. CHAMPUS stands for Civilian Health and Medical Program of Veterans Affairs.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: D | Question # 5 Answer: A |
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