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Medical Administrative Assistant / Office Specialist Exam Content Outline
Domain Areas:
(I) Paper & Electronic Medical Records (II) Medical Coding
(III) Medical Billing & Processing Claims (IV) Insurance
(V) Healthcare Laws & Regulations (VI) Appointments & Scheduling (VII) Communication
(VIII) Financial management & office supplies
DOMAIN AREAS CHECK
Domain I : Paper & Electronic Medical Records
• Clinical Records & Medical Document • Medical Charts
• Filing the Chart
• Medical Documentation Rules • SOAP Notes
• Signature Cards • Retention of Records • Storing Medical Records • Electronic Medical Charting • Computerized Files
• Record Transfers
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• Release of Information Form • Assignment of Benefits Form • Patient History Form
• Medical Abbreviations & Terminology
• Following Electronic Health Record Standards • The Clinic Administration
• The Patient's Chart
• Transitioning to an Electronic Health Record • Implementation of EHR
• Harmful Events • Medical Errors • Conversion of Data
• Paper vs Electronic Health Records • Protected Health Information • Personal Health Records
Document Scanning
Document Printing
Document Fax
Document Mailing
Document Appearance , Timeliness & Accuracy
Document Correcting, Amendments, Deletions & Retraction Policy
Release of Medical Record
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Domain II :Medical Coding
ICD-9-CM, Determining & Assigning CPT, Determining & Assigning
HCPCS Level II Codes, Determining & Assigning
International Classification of Disease (ICD-9-CM) Coding • How to Use the ICD-9-CM Index & Tabular List • General Guidelines
• Main Terms
• V Codes
• E Codes
• Signs and Symbols Used in the ICD-9-CM
Current Procedural Terminology (CPT) Coding • Using the CPT
• Semicolons in the CPT
• Signs and Symbols Used in the CPT • CPT Index
• CPT Modifiers • CPT Category I
a) Evaluation and Management Codes Section b) Anesthesia Section
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c) Surgery Section d) Radiology/X-ray Section e) Pathology/Laboratory Section f) Medicine Section • CPT Category II a) Performance Measurements • CPT Category III a) Emerging Technology
Domain III :Medical Billing & Processing Claims
• Claim Audits
• Delinquent Claims
• Medical Practice Accounting • Patient Accounting
• Accounts Payable/Receivable
• Patient Ledger Card/Statement of Account • Insurance Payments • Patient Payments • Posting Payments • Balance Billing • Follow-Ups • Collections
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• Collections Procedures • Small Claims Court • Practice Accounting • Petty Cash
• The Day Sheet/Daily Journal • Office Reports
• CMS-1500 Form and Medical Billing Procedures • Superbill
• CMS-1500 Form
• Patient Claim Form • Billing for Services
• Determining the Proper Billing Amount • Special Services
• Claims Submission Process • Clean Claims
• Coordination of Benefits
• Health Maintenance Organizations • Collecting the Patient Portion • Billing Reports
• Prompt Payment Laws
• Tracer Claims/Delinquent Claims • Denied Claims
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• Adjusted Claims • Review and Appeals
• Balance Billing Patients for Down-coded or Denied Claims • The UB-92 Form and Hospital Billing Procedures
• Uniform Bill (UB-04) • Assignment of Benefits
• Charge master & Superbill Descriptions • Entering Charges
• Preauthorization, Precertification and Utilization Reviews • Patient Information Sheet
• Insurance Coverage Form • Patient Claim Form
• Superbill/Charge Slip • Insurance Claim Register • Aging report • Remainder statement • Standard statement • Face sheet • Informed consent • Incident report • Day sheet
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Domain IV :Insurance
Insurance Verification / Preauthorization Pre-Authorization
• Process
• Request
• Forms
Tricare, Blue Cross/ Blue Shield
• Tricare Plan, Blue Cross/ Blue Shield Plan • Tricare Claim, Blue Cross/ Blue Shield Claims
Commercial Insurance
• Commercial Insurance Plan • Commercial Insurance Claim
Medicare and Medicaid
• Medicare
• Medicare Eligibility • The Parts of Medicare • Allowable Charges
• Medicare Physician Identification Numbers • Medicare Billing Notices
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• Assignment of Benefits • Medicare Secondary Payer • Durable Medical Equipment • Medicare Denials
• Advance Beneficiary Notice (ABN) • The Medicare Appeals Process • Medicare Fraud and Abuse
• Medicare Supplemental Insurance • Medicare and Managed Care • Medicare Notice of Non-Coverage • Medicare Billing Guidelines
• Medicaid
• Medicaid Covered Services • Reimbursement from Medicaid • Medicaid as Secondary Payer • Treatment Authorization Request
Workers' Compensation • Fraud and Abuse
• Types of Workers' Compensation Benefits • Patient Records
• Doctor's First Report of Injury/Illness • Progress Reports
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• Workers' Compensation Appeals • Office Administration
Domain V :Healthcare Laws & Regulations
HIPAA
o Security rule o Privacy rule
o Administrative simplification process o Covered entities HIPAA TITILE o Title 1 o Title 2 o Title 3 o Title 4 o Title 5
Medical Law & Ethics
Legal Issues In Healthcare o Fraud
o Negligence o Malpractice o Battery
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o Tort o Libel o Slander o Defamation o Assault o Duty of care o Standard of care o Liability
Domain VI :Appointment & Scheduling
Creating an appointment
Scheduling an appointment
Organizing Appointments
Confirming & Reminder Appointment Calls
Electronic Scheduling Domain VII :Communication
Communication with patient
Communication with coworkers
Customer Service
Patient Reception
Domain VIII :Financial management & office supplies
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Maintaining Office Equipments
Managing & Ordering Supply Inventory
Recycling Office Supplies and Medical Waste
