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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Denials, appeals, corrections - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses |
| Topic 2: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management - Patient statements, collections |
| Topic 3: Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 4: Billing Regulations | 13% | - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Topic 5: HIPAA and Compliance | 9% | - Compliance programs - Privacy, security, transaction standards - Medical record retention - Fraud, abuse, False Claims Act |
| Topic 6: Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Medicare, Medigap, Medicaid - Managed care plans |
| Topic 7: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
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NEW QUESTION # 145
What does it mean by inter?
Answer: C
NEW QUESTION # 146
What does CDT stand for?
Answer: D
NEW QUESTION # 147
DCAO
Answer: A
NEW QUESTION # 148
Blue Cross Blue Shield Association (BCBSA) is an association of independent Blue Cross Blue Shield plans.
Answer: B
NEW QUESTION # 149
Blue Shield (BS) __________
Answer: D
NEW QUESTION # 150
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