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