Medical Coding and Billing Specialist Study Guide

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Topical Study Guide

I.  ICD-10-PCS Coding (25%)

• ICD-10-PCS coding based on documentation provided

II.  ICD-10-CM Coding (15%)

• Coding of diagnosis based on documentation provided

III.  Coding Guidelines and Coding Conventions (10%)

• Guidelines used for ICD-10-PCS coding for correct coding
• ICD-10-CM coding guidelines for Coding and Reporting
• ICD-10-CM coding conventions used in the ICD-10-CM book

IV.  Insurance (25%)

• Roles and responsibilities of a Medical Biller
• Claims processing
• Appeals Process
• Compliance and regulations pertaining to medical billing
• Fraud and Abuse
• Place of service reporting
• HIPAA regulations

V.  Commercial and Private Carrier Systems (10%)

• Participating vs. non-participating providers
• Insurance Carrier guidelines
• Types of insurance policies

VI.  State and Federal Programs (15%)

• Medicare Parts A, B, C, D
• Medicaid
• Tricare and Veterans Affairs
• Relative Values Units utilization
• Eligibility for state and federal programs
• Utilization and Quality Control

 

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