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| Section | Weight | Objectives |
|---|---|---|
| Insurance and Reimbursement | 20-25% | - Coordination of benefits - Fee schedules and reimbursement methodologies - Commercial insurance policies - Workers' compensation and no-fault billing - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) |
| ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - Code accuracy and specificity - ICD-10-CM structure and conventions - Principal diagnosis selection - Chapter-specific guidelines |
| Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Revenue cycle overview - Anatomy and physiology for billers - Healthcare documentation principles |
| Billing Compliance and Regulations | 10-15% | - HIPAA privacy and security requirements - Appeal and denial management - Documentation compliance - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics |
| CPT Coding | 20-25% | - Category II and III codes - Modifiers and their appropriate use - Evaluation and Management (E/M) codes - Surgical procedure codes - CPT code categories and structure |
| Practice Management | 10-15% | - Patient responsibility calculations - Patient registration and demographics - Insurance verification processes - Accounts receivable management - Collections and payment posting |
What does ANSI stand for?
Correct Answer: B 🗳️
BCBS stands for Blue Cross Blue Shield.
Correct Answer: A 🗳️
Which professional association was founded to elevate the standards of medical coding by providing certification, ongoing education, networking, and recognition for coders?
Correct Answer: C 🗳️
What is All Patient DiagnosisRelated Group (APDRG)?
Correct Answer: B 🗳️
HPSA stands for Health Personnel Shortage Area.
Correct Answer: A 🗳️
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