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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Medicare, Medigap, Medicaid |
| Topic 2: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Patient statements, collections - Payment posting, adjustments - Accounts receivable management |
| Topic 3: Claims and Billing | 14% | - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules - Denials, appeals, corrections |
| Topic 4: Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Topic 5: Billing Regulations | 13% | - Incident-to billing, global packages - Payer payment policies - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs |
| Topic 6: Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers |
| Topic 7: HIPAA and Compliance | 9% | - Medical record retention - Compliance programs - Privacy, security, transaction standards - Fraud, abuse, False Claims Act |
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NEW QUESTION # 157
Cafeteria plan is also called triple option plan; provides different health benefits plans and extra coverage options through an insure or third-party administrator.
Answer: A
NEW QUESTION # 158
What does it mean by dacry?
Answer: D
NEW QUESTION # 159
Accounts Receivable Management
Answer: D
NEW QUESTION # 160
CLIA
Answer: D
NEW QUESTION # 161
Adverse Selection includes covering members who are sicker then the general population.
Answer: A
NEW QUESTION # 162
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