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| Section | Weight | Objectives |
|---|---|---|
| ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - Secondary diagnosis coding - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions |
| Practice Management | 10-15% | - Patient responsibility calculations - Accounts receivable management - Insurance verification processes - Collections and payment posting - Patient registration and demographics |
| CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - Modifiers and their appropriate use - Surgical procedure codes - CPT code categories and structure - Category II and III codes |
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Healthcare documentation principles - Anatomy and physiology for billers - Medical terminology basics |
| Insurance and Reimbursement | 20-25% | - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Commercial insurance policies - Coordination of benefits - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing |
| Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Fraud, waste, and abuse prevention - Appeal and denial management - Documentation compliance |
1. What does BS stand for?
A) Beneficiary Standards
B) Blue Shield
C) Beneficiary Services
D) Black Shield
2. FPL
A) Federal Poverty Level
B) General Equivalency Mapping
C) Flexible Spending Account
D) Federal Register
3. Which payer typically requires prior authorization for certain services?
A) Only Medicare
B) Commercial and managed care plans
C) All payers equally
D) Medicaid only
4. GEP stands for General Enrollment Period.
A) TRUE
B) FALSE
5. Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: A | Question # 3 Answer: B | Question # 4 Answer: A | Question # 5 Answer: A |
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