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| Section | Weight | Objectives |
|---|---|---|
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages |
| Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act |
| Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up |
| Types of Insurance | 21% | - Third-party liability - Medicare, Medigap, Medicaid - Managed care plans - Commercial payers - TRICARE/CHAMPUS, Workers' compensation |
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NEW QUESTION # 30
EPO
Answer: A
NEW QUESTION # 31
Catastrophic cap benefit protects TRICARE beneficiaries form devastating financial loss due to serious illness or long-term treatment by establishing limits over which payments is not required.
Answer: A
NEW QUESTION # 32
CRI
Answer: C
NEW QUESTION # 33
837
Answer: C
NEW QUESTION # 34
HICN stands for Health Insurance claim number.
Answer: A
NEW QUESTION # 35
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