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High-Yield Review: Domains 4-6 (Regulations, Revenue Cycle, IT)

Duration: 55 min · Level: Advanced · Module: 10. CEHRS Exam Strategy & Final Review · Focus: exam-review, HIPAA, revenue-cycle, IT, high-yield

Learning objectives

By the end of this lesson you will be able to explain and apply:

  • HIPAA Privacy must-knows
  • HIPAA Security must-knows
  • Revenue cycle must-knows
  • ICD-10 must-knows
  • CPT must-knows

You will then consolidate these ideas in the hands-on lab below.

Why this matters​

The final 37% of the exam.

Overview​

The final 37% of the exam. HIPAA questions are the most nuanced — small differences in scenario details change the correct answer completely. Revenue cycle and IT questions reward candidates who know the exact numbers and procedures, not just general concepts.

Key concepts​

Key idea

HIPAA Privacy must-knows: 18 PHI identifiers (especially dates, geographic, device/vehicle IDs); 6 patient rights with exact timelines (30-day access, 60-day accounting); minimum necessary applies to all disclosures except treatment among providers; authorization required for psychotherapy notes always

  • HIPAA Security must-knows: risk analysis is REQUIRED (not addressable); encryption makes a lost device a non-breach; breach notification: 60 days from discovery for all sizes; ≥500 = also notify media and HHS immediately; <500 = annual HHS report by March 1
  • Revenue cycle must-knows: clean claim rate target >95%; days in A/R target <50; front-end (registration) denials are cheaper to prevent than back-end; prior authorization required before service; real-time eligibility = 270/271 transaction
  • ICD-10 must-knows: first character is always a letter (A-Z); 3-7 characters; decimal after 3rd character; principal diagnosis = reason for admission after study; specificity affects reimbursement
  • CPT must-knows: modifier -25 for E&M same day as procedure; modifier -59 for distinct procedural service; E&M levels based on MDM complexity or time (post-2021); HCPCS Level II for supplies and drugs
  • IT domain must-knows: RBAC = roles not individuals; audit trails cannot be deleted; automatic logoff is a technical safeguard; HL7 v2 used in hospital messaging; FHIR R4 required since April 2021; information blocking = federal offense under Cures Act
Hands-on lab

Complete a final 30-question practice drill covering Domains 4-6. Then review the complete 10-day study calendar: Days 1-2 (Domains 1-2), Days 3-4 (Domains 3-4), Days 5-6 (Domains 5-6), Day 7 (full-length 130-question practice exam), Days 8-9 (targeted review of weakest areas), Day 10 (light review only, sleep well, exam day)

Check your understanding​

Try to recall each answer before expanding it.

Q1. What do you know about HIPAA Privacy must-knows?

18 PHI identifiers (especially dates, geographic, device/vehicle IDs); 6 patient rights with exact timelines (30-day access, 60-day accounting); minimum necessary applies to all disclosures except treatment among providers; authorization required for psychotherapy notes always

Q2. What do you know about HIPAA Security must-knows?

risk analysis is REQUIRED (not addressable); encryption makes a lost device a non-breach; breach notification: 60 days from discovery for all sizes; ≥500 = also notify media and HHS immediately; <500 = annual HHS report by March 1

Q3. What do you know about Revenue cycle must-knows?

clean claim rate target >95%; days in A/R target <50; front-end (registration) denials are cheaper to prevent than back-end; prior authorization required before service; real-time eligibility = 270/271 transaction

Q4. What do you know about ICD-10 must-knows?

first character is always a letter (A-Z); 3-7 characters; decimal after 3rd character; principal diagnosis = reason for admission after study; specificity affects reimbursement

Q5. What do you know about CPT must-knows?

modifier -25 for E&M same day as procedure; modifier -59 for distinct procedural service; E&M levels based on MDM complexity or time (post-2021); HCPCS Level II for supplies and drugs

← Previous: C10.2 High-Yield Review: Domains 1-3 (Documentation, Terminology, HIM)

Part of Module 10: CEHRS Exam Strategy & Final Review.