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| Section | Objectives |
|---|---|
| Medical Billing Fundamentals | - Insurance types and payer structures - Medical billing workflow and revenue cycle - Healthcare reimbursement systems |
| Coding and Claim Submission Basics | - Claims submission processes - ICD-10-CM, CPT, and HCPCS overview - Use of modifiers and coding compliance |
| Compliance and Regulations | - Billing compliance standards - HIPAA and patient privacy rules - Fraud and abuse prevention |
| Revenue Cycle Management | - Claims denial and rejection management - Payment posting and reconciliation - Accounts receivable follow-up |
| Insurance Processing and Payer Rules | - Private insurance policies and contracts - Coordination of benefits (COB) - Medicare and Medicaid guidelines |
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 scenario would most likely result in a claim denial for lack of medical necessity?
A) Incorrect patient demographics
B) Late filing
C) Diagnosis code does not support the procedure
D) Missing modifier
3. What does the acronym CT stand for?
A) Defense Enrollment Eligibility Reporting System
B) Debt Collection Assistance Officer
C) Computed Tomography
D) Durable Medical Equipment
4. What is the provider's responsibility when a patient has a copayment?
A) Waive it routinely
B) Write it off automatically
C) Bill it to insurance
D) Collect it at the time of service
5. Case mix includes the types and categories of patients treated by a healthcare provider.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: C | Question # 3 Answer: C | Question # 4 Answer: D | Question # 5 Answer: A |
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