Medical Coding and Billing Study Guide

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Topical Breakdown

Use the following topical guide to help you prepare for the exam:

I.  CPT Coding (25%)

• CPT coding based on documentation provided

II.  ICD-10-CM Coding (15%)

• Coding of diagnosis based on documentation provided

III.  Coding Guidelines & Conventions (10%)

• Guidelines used for CPT coding
• Use of modifiers with CPT 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 & Private Carrier Systems (10%)

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

VI.  State & 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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