Last Updated: Aug 23, 2026
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| Section | Objectives |
|---|---|
| Topic 1: Coding and Claim Submission Basics | - Claims submission processes - Use of modifiers and coding compliance - ICD-10-CM, CPT, and HCPCS overview |
| Topic 2: Medical Billing Fundamentals | - Medical billing workflow and revenue cycle - Insurance types and payer structures - Healthcare reimbursement systems |
| Topic 3: Revenue Cycle Management | - Accounts receivable follow-up - Claims denial and rejection management - Payment posting and reconciliation |
| Topic 4: Compliance and Regulations | - Fraud and abuse prevention - HIPAA and patient privacy rules - Billing compliance standards |
| Topic 5: Insurance Processing and Payer Rules | - Medicare and Medicaid guidelines - Private insurance policies and contracts - Coordination of benefits (COB) |
1. The word root "acr" (or "acro-") refers to:
A) fat
B) extremities, top
C) toward
2. The medical prefixes "hypo-" or "hyp-" mean:
A) above, excessive
B) uterus, womb
C) below, under
D) condition
3. What is Allowed Charge?
A) The amount the payer will reimburse for each procedure or service, according to the patients policy.
B) The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.
C) The Minimum amount the payer will reimburse for each procedure or service, according to the patients policy.
4. What does it mean by graphy?
A) process of publishing
B) process of recording
5. Allowable Charge
A) See limiting charge; maximum fee a physician may charge.
B) Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
C) The Maximum amount the payer will reimburse for each procedure or service, according to the patients policy.
D) DRG system adapted for use by thirdparty payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross Blue Shield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
Solutions:
| Question # 1 Answer: B | Question # 2 Answer: C | Question # 3 Answer: B | Question # 4 Answer: B | Question # 5 Answer: A |
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