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| Section | Weight | Objectives |
|---|---|---|
| Billing Compliance and Regulations | 10-15% | - Stark Law and Anti-Kickback Statute basics - Documentation compliance - Appeal and denial management - HIPAA privacy and security requirements - Fraud, waste, and abuse prevention |
| Practice Management | 10-15% | - Accounts receivable management - Collections and payment posting - Insurance verification processes - Patient registration and demographics - Patient responsibility calculations |
| ICD-10-CM Diagnosis Coding | 15-20% | - Chapter-specific guidelines - ICD-10-CM structure and conventions - Secondary diagnosis coding - Code accuracy and specificity - Principal diagnosis selection |
| Insurance and Reimbursement | 20-25% | - Workers' compensation and no-fault billing - Commercial insurance policies - Claims submission and processing - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Coordination of benefits |
| CPT Coding | 20-25% | - Modifiers and their appropriate use - Evaluation and Management (E/M) codes - Surgical procedure codes - CPT code categories and structure - Category II and III codes |
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Healthcare documentation principles - Anatomy and physiology for billers |
Question 1
DCAO
A. Durable Medical Equipment, Prosthetic and Orthotic Supplies
B. Debt Collection Assistance Officer
C. Defense Enrollment Eligibility Reporting System
D. Durable Medical Equipment
Question 2
What does it mean by dextr?
A. left
B. right
Question 3
BCBS stands for Blue Cross Blue Shield.
A. TRUE
B. FALSE
Question 4
EHNAC
A. Electronic Media Claim
B. Electronic Healthcare Network Accreditation Commission
C. Evaluation and Management
D. Electronic Health Record
Question 5
What are actions inconsistent with accepted, sound medical business or fiscal practice?
A. Neglect
B. Abuse
C. Addiction
D. Violence
Solutions:
| Question 1 Answer: B | Question 2 Answer: B | Question 3 Answer: A | Question 4 Answer: B | Question 5 Answer: B |
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