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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Coordination of benefits - Claims submission and processing - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Workers' compensation and no-fault billing |
| Topic 2: CPT Coding | 20-25% | - Surgical procedure codes - Category II and III codes - Evaluation and Management (E/M) codes - CPT code categories and structure - Modifiers and their appropriate use |
| Topic 3: Billing Compliance and Regulations | 10-15% | - Documentation compliance - Fraud, waste, and abuse prevention - Stark Law and Anti-Kickback Statute basics - HIPAA privacy and security requirements - Appeal and denial management |
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Principal diagnosis selection - ICD-10-CM structure and conventions - Secondary diagnosis coding - Chapter-specific guidelines - Code accuracy and specificity |
| Topic 5: Healthcare Billing Fundamentals | 15-20% | - Anatomy and physiology for billers - Medical terminology basics - Revenue cycle overview - Healthcare documentation principles |
| Topic 6: Practice Management | 10-15% | - Patient responsibility calculations - Collections and payment posting - Insurance verification processes - Patient registration and demographics - Accounts receivable management |
HSA stands for Health Savings account.
Correct Answer: B 🗳️
Case management is development of patient care plans to coordinate and provide care for complicated cases in a cost effective manner.
Correct Answer: B 🗳️
What is the provider's responsibility when a patient has a copayment?
Correct Answer: A 🗳️
Explanation: Only visible for ValidTorrent members. You can sign-up / login (it's free).
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?
Correct Answer: B 🗳️
ilio
Correct Answer: A 🗳️
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