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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Insurance and Reimbursement | 20-25% | - Commercial insurance policies - Government payers (Medicare, Medicaid, TRICARE) - Claims submission and processing - Coordination of benefits - Workers' compensation and no-fault billing - Fee schedules and reimbursement methodologies |
| Topic 2: Billing Compliance and Regulations | 10-15% | - Stark Law and Anti-Kickback Statute basics - Appeal and denial management - Fraud, waste, and abuse prevention - Documentation compliance - HIPAA privacy and security requirements |
| Topic 3: CPT Coding | 20-25% | - CPT code categories and structure - Surgical procedure codes - Modifiers and their appropriate use - Category II and III codes - Evaluation and Management (E/M) codes |
| Topic 4: ICD-10-CM Diagnosis Coding | 15-20% | - Chapter-specific guidelines - Code accuracy and specificity - Principal diagnosis selection - Secondary diagnosis coding - ICD-10-CM structure and conventions |
| Topic 5: Practice Management | 10-15% | - Accounts receivable management - Insurance verification processes - Collections and payment posting - Patient registration and demographics - Patient responsibility calculations |
| Topic 6: Healthcare Billing Fundamentals | 15-20% | - Medical terminology basics - Anatomy and physiology for billers - Healthcare documentation principles - Revenue cycle overview |
1. What does GEM stand for?
A) Geographic Equivalency Mapping
B) Group Enrollment Management
C) General Equivalency Mapping
D) General Enrollment Management
2. Which of the following suffixes refers to out?
A) ex
B) infra
C) end, endo
D) en
3. GCPI stands for Geographic Cost Practice Index.
A) TRUE
B) FALSE
4. Ambulatory Surgical Center (ASC) includes State Licensed Medicare-certified supplier (not provider) of surgical healthcare services that must accept assignment on Medicare Claims.
A) TRUE
B) FALSE
5. arthr
A) joint
B) condition
C) two
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: A |
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