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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Practice Management | 10-15% | - Patient registration and demographics - Insurance verification processes - Collections and payment posting - Patient responsibility calculations - Accounts receivable management |
| Topic 2: ICD-10-CM Diagnosis Coding | 15-20% | - Secondary diagnosis coding - ICD-10-CM structure and conventions - Code accuracy and specificity - Chapter-specific guidelines - Principal diagnosis selection |
| Topic 3: CPT Coding | 20-25% | - Modifiers and their appropriate use - Evaluation and Management (E/M) codes - Surgical procedure codes - Category II and III codes - CPT code categories and structure |
| Topic 4: Insurance and Reimbursement | 20-25% | - Government payers (Medicare, Medicaid, TRICARE) - Fee schedules and reimbursement methodologies - Coordination of benefits - Workers' compensation and no-fault billing - Claims submission and processing - Commercial insurance policies |
| Topic 5: Healthcare Billing Fundamentals | 15-20% | - Revenue cycle overview - Anatomy and physiology for billers - Medical terminology basics - Healthcare documentation principles |
| Topic 6: Billing Compliance and Regulations | 10-15% | - Fraud, waste, and abuse prevention - Appeal and denial management - HIPAA privacy and security requirements - Documentation compliance - Stark Law and Anti-Kickback Statute basics |
1. Beneficiary counseling and assistance coordinator (BCAC) is individual available at military treatment facility (MTF) to answer questions, help solve healthcare related problems, and assist beneficiaries in obtaining medical care through TRICARE; was previously called health benefits advisor (HBA).
A) TRUE
B) FALSE
2. Which part of the body does gloss refer to?
A) tongue
B) teeth
C) lips
D) cheek
3. CMP
A) UB04 Claim used by institutional and other selected providers to
B) Competitive Medical Plan
C) Centers of Medicare and Medicaid Services
D) Insurance claim used by noninstitutional providers and supplier to bill payers
4. The medical prefixes "hypo-" or "hyp-" mean:
A) below, under
B) uterus, womb
C) above, excessive
D) condition
5. fore
A) genitals
B) milk
C) before
D) stomach
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: B | Question # 4 Answer: A | Question # 5 Answer: C |
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