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| Section | Weight | Objectives |
|---|---|---|
| Practice Management | 10-15% | - Accounts receivable management - Insurance verification processes - Patient responsibility calculations - Collections and payment posting - Patient registration and demographics |
| CPT Coding | 20-25% | - Surgical procedure codes - Modifiers and their appropriate use - Category II and III codes - Evaluation and Management (E/M) codes - CPT code categories and structure |
| Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Coordination of benefits - Claims submission and processing - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies |
| Billing Compliance and Regulations | 10-15% | - Appeal and denial management - HIPAA privacy and security requirements - Stark Law and Anti-Kickback Statute basics - Documentation compliance - Fraud, waste, and abuse prevention |
| ICD-10-CM Diagnosis Coding | 15-20% | - Chapter-specific guidelines - Code accuracy and specificity - Secondary diagnosis coding - ICD-10-CM structure and conventions - Principal diagnosis selection |
| Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles |
Which document communicates to the payer that the provider is requesting reimbursement?
Correct Answer: C 🗳️
DCAO
Correct Answer: A 🗳️
Medical Ethics are principles of right or good conduct.
Correct Answer: B 🗳️
CAC (Choose two.)
Correct Answer: A,B 🗳️
DME
Correct Answer: D 🗳️
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