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| Section | Weight | Objectives |
|---|---|---|
| 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 |
| Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Medical terminology basics - Healthcare documentation principles - Revenue cycle overview |
| Insurance and Reimbursement | 20-25% | - Fee schedules and reimbursement methodologies - Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Workers' compensation and no-fault billing - Commercial insurance policies - Coordination of benefits |
| CPT Coding | 20-25% | - Surgical procedure codes - Category II and III codes - CPT code categories and structure - Modifiers and their appropriate use - Evaluation and Management (E/M) codes |
| Practice Management | 10-15% | - Patient registration and demographics - Patient responsibility calculations - Insurance verification processes - Collections and payment posting - Accounts receivable management |
| ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - Chapter-specific guidelines - ICD-10-CM structure and conventions - Principal diagnosis selection - Secondary diagnosis coding |
1. Birthday rule determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
A) FALSE
B) TRUE
2. BCBSA stands for Blue Cross Blue Shield Association.
A) FALSE
B) TRUE
3. Who is a person who performs services for another under an expressed or implied agreement?
A) Healthcare Provider
B) Independent Contractor
C) Health Insurance Specialist
4. What does it mean by graph?
A) instrument for hearing
B) instrument for speaking
C) process of recording
D) instrument for reading
5. HPSA stands for Health Personnel Shortage Area.
A) FALSE
B) TRUE
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: B | Question # 3 Answer: B | Question # 4 Answer: D | Question # 5 Answer: B |
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