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| Section | Objectives |
|---|---|
| Compliance and Regulations | - Billing compliance standards - Fraud and abuse prevention - HIPAA and patient privacy rules |
| Revenue Cycle Management | - Payment posting and reconciliation - Claims denial and rejection management - Accounts receivable follow-up |
| Coding and Claim Submission Basics | - Use of modifiers and coding compliance - ICD-10-CM, CPT, and HCPCS overview - Claims submission processes |
| Insurance Processing and Payer Rules | - Medicare and Medicaid guidelines - Private insurance policies and contracts - Coordination of benefits (COB) |
| Medical Billing Fundamentals | - Insurance types and payer structures - Healthcare reimbursement systems - Medical billing workflow and revenue cycle |
1. CMS1500
A) Coordination of Benefits
B) Insurance claim used by noninstitutional providers and supplier to bill payers
C) Consolidated Omnibus Budget Reconciliation Act of 1985
D) Clinical nurse specialist
2. What does it mean by gyn, gyne and gynec?
A) women, female
B) men, male
3. Benefit period (Medicare) __________
A) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 120 consecutive days.
B) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 90 consecutive days.
C) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days.
D) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 30 consecutive days.
4. EHNAC
A) Electronic Healthcare Network Accreditation Commission
B) Electronic Media Claim
C) Evaluation and Management
D) Electronic Health Record
5. CDHP stands for Consumer Directed Health Plan.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: A | Question # 3 Answer: C | Question # 4 Answer: A | Question # 5 Answer: A |
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