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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: CPT Coding | 20-25% | - CPT code categories and structure - Surgical procedure codes - Category II and III codes - Modifiers and their appropriate use - Evaluation and Management (E/M) codes |
| Topic 2: Insurance and Reimbursement | 20-25% | - Claims submission and processing - Coordination of benefits - Government payers (Medicare, Medicaid, TRICARE) - Workers' compensation and no-fault billing - Commercial insurance policies - Fee schedules and reimbursement methodologies |
| Topic 3: Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements - Documentation compliance |
| Topic 4: Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles - Revenue cycle overview |
| Topic 5: 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 6: Practice Management | 10-15% | - Patient responsibility calculations - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Accounts receivable management |
Which factor determines the correct payer sequence in coordination of benefits (COB)?
Correct Answer: D 🗳️
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ASC (Choose two.)
Correct Answer: C,D 🗳️
What does BS stand for?
Correct Answer: B 🗳️
What does it mean by dis?
Correct Answer: A 🗳️
The medical word root "ileo" refers to the:
Correct Answer: C 🗳️
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