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| Section | Objectives |
|---|---|
| Topic 1: Revenue Cycle Management | - Payment posting and reconciliation - Claims denial and rejection management - Accounts receivable follow-up |
| Topic 2: Medical Billing Fundamentals | - Insurance types and payer structures - Healthcare reimbursement systems - Medical billing workflow and revenue cycle |
| Topic 3: Insurance Processing and Payer Rules | - Coordination of benefits (COB) - Medicare and Medicaid guidelines - Private insurance policies and contracts |
| Topic 4: Coding and Claim Submission Basics | - Use of modifiers and coding compliance - Claims submission processes - ICD-10-CM, CPT, and HCPCS overview |
| Topic 5: Compliance and Regulations | - Fraud and abuse prevention - HIPAA and patient privacy rules - Billing compliance standards |
1. A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?
A) Medicare
B) Commercial insurance
C) Secondary insurance
D) Medicaid
2. Current Procedural Terminology (CPT) is used to report professional services to payers.
A) TRUE
B) FALSE
3. Case management services is a process by which an attending physician coordinates and supervises care provided to patient by other providers.
A) TRUE
B) FALSE
4. The medical prefixes "hypo-" or "hyp-" mean:
A) uterus, womb
B) condition
C) below, under
D) above, excessive
5. BCBSA stands for Blue Cross Blue Shield Association.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: C | Question # 5 Answer: A |
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