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| Section | Weight | Objectives |
|---|---|---|
| Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Managed care plans - Third-party liability - Medicare, Medigap, Medicaid |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules - Denials, appeals, corrections |
| Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments |
| Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages |
| Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPTยฎ, HCPCS Level II - Code validation, modifiers |
| HIPAA and Compliance | 9% | - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards |
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NEW QUESTION # 132
What does CF stand for?
Answer: C
NEW QUESTION # 133
Bonding insurance is an insurance agreement that guarantees repayment for financial losses resulting from the act or failure to act of an employee. It protects the financial operations of the employer.
Answer: B
NEW QUESTION # 134
CSCP
Answer: A
NEW QUESTION # 135
Adjudication
Answer: B
NEW QUESTION # 136
What does HPMP stand for?
Answer: B
NEW QUESTION # 137
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