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This problem set is a comprehensive educational material containing a total of 500 questions, covering everything from the basics of the medical insurance system to the calculation of complex medical fees and the practical aspects of receipt inspection. ■ Structure of this Book We will systematically develop your skills from basic to applied knowledge, aligning with each section of the exam. • Chapter 1: Fundamentals of the Medical Insurance System (Questions 1~) • System Basics: Basic rules such as the classification of Japan's public medical insurance (employment-based insurance and community-based insurance) and the timing of loss of insured status. • Benefit System: The principle of in-kind benefits, the mechanism of self-pay limits in the high-cost medical expense benefit system, and various allowances such as the lump-sum birth allowance. • Chapter 2: Calculation of Medical Fees • Outpatient, Inpatient, and Home Care: Requirements for calculating charges for procedures, examinations, and medications. For example, you will learn detailed rules such as the time-based distinctions between psychiatric short-stay care (3 hours or more, less than 6 hours) and day care (6 hours or more). • Home Visit Care: Calculation methods under specific circumstances, such as psychiatric home nursing and guidance fees. • Chapter 3: Practical Work and Receipt Inspection • Key Points for Inspection: Practical checking methods to prevent "returns (rejections)" by verifying if medical services are medically appropriate for the diagnosed condition and if there are any omissions in the summary section. • Chapter 4: Patient Reception and Front Desk Operations • Chapter 5: Receipt Creation and Inspection (Applied Exercises) ■ Features and Important Points of this Book • Wide Range of Question Formats from "True/False" to "Multiple Choice" By combining true/false questions to confirm basic knowledge with four-choice questions simulating the actual exam, we ensure that knowledge is firmly retained. • Thorough Explanation of Complex Calculation Rules The most challenging aspect of medical administration, "the calculation of medical fee points," is explained in detail, including the reasons why certain services cannot be billed in specific cases. • Case Study Problems to Develop Practical Skills This section focuses on points where errors are likely to occur in actual practice, such as the necessary entries in the summary section when specific medications are used during receipt inspection. ■ Recommended for • Those who want to ensure they pass the Medical Administrative Skills Proficiency Examination (Medical Clerk). • Those who want to master the complex rules and calculation methods of medical fees through numerous practice problems. • Those who aim to work or change careers in reception or administrative positions at hospitals and clinics and want to acquire immediately applicable knowledge. • Current medical administrative staff who want to improve their knowledge of the latest billing rules and the accuracy of receipt inspection.
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