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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Practice Management | 10-15% | - Accounts receivable management - Insurance verification processes - Collections and payment posting - Patient responsibility calculations - Patient registration and demographics |
| Topic 2: ICD-10-CM Diagnosis Coding | 15-20% | - Code accuracy and specificity - ICD-10-CM structure and conventions - Secondary diagnosis coding - Chapter-specific guidelines - Principal diagnosis selection |
| Topic 3: Billing Compliance and Regulations | 10-15% | - Appeal and denial management - Fraud, waste, and abuse prevention - HIPAA privacy and security requirements - Documentation compliance - Stark Law and Anti-Kickback Statute basics |
| Topic 4: Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Coordination of benefits - Workers' compensation and no-fault billing - Claims submission and processing |
| Topic 5: Healthcare Billing Fundamentals | 15-20% | - Healthcare documentation principles - Anatomy and physiology for billers - Revenue cycle overview - Medical terminology basics |
| Topic 6: CPT Coding | 20-25% | - Category II and III codes - CPT code categories and structure - Modifiers and their appropriate use - Evaluation and Management (E/M) codes - Surgical procedure codes |
dactyl
Correct Answer: B 🗳️
Ambulance Fee Schedule is payment system for ambulance services provided to Medicare Beneficiaries.
Correct Answer: B 🗳️
EGHP
Correct Answer: A 🗳️
CPC
Correct Answer: A 🗳️
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