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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Practice Management | 10-15% | - Insurance verification processes - Patient registration and demographics - Patient responsibility calculations - Accounts receivable management - Collections and payment posting |
| Topic 2: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles |
| Topic 3: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions - Secondary diagnosis coding - Principal diagnosis selection |
| Topic 4: CPT Coding | 20-25% | - Evaluation and Management (E/M) codes - Surgical procedure codes - Category II and III codes - CPT code categories and structure - Modifiers and their appropriate use |
| Topic 5: Billing Compliance and Regulations | 10-15% | - Documentation compliance - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - Appeal and denial management |
| Topic 6: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Coordination of benefits - Fee schedules and reimbursement methodologies - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing |
1. What does the acronym FR stand for?
A) General Equivalency Mapping
B) Federal Register
C) General Enrollment Period
D) Flexible Spending Account
2. What does it mean by brachy?
A) tall
B) short
3. What is Ambulatory Surgical Center Payment Rate?
A) Predetermined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
B) Predetermined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
C) Determined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
D) Determined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
4. DMERC
A) Department of Defense
B) Durable Medical Equipment regional carriers
C) Disproportionate share hospital (adjustment)
D) Diagnosis related groups
5. EPSDT
A) Electronic Remittance Advice
B) External Quality Review Organization
C) Early and Periodic screening, diagnostic, and treatment
D) Employee Retirements income security Act of 1974
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: B | Question # 3 Answer: B | Question # 4 Answer: B | Question # 5 Answer: C |
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