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| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Managed care plans - Commercial payers - Third-party liability - TRICARE/CHAMPUS, Workers' compensation |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Reimbursement and Collections | 14% | - Accounts receivable management - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
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NEW QUESTION # 89
The medical word root "hyster" or "hyster/o" refers to the:
Answer: C
NEW QUESTION # 90
What does GEM stand for?
Answer: D
NEW QUESTION # 91
Blue Cross Blue Shield Association (BCBSA) is an association of independent Blue Cross Blue Shield plans.
Answer: B
NEW QUESTION # 92
What does the acronym EHR stand for?
Answer: B
NEW QUESTION # 93
What does it mean by galact and lact?
Answer: B
NEW QUESTION # 94
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