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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages |
| Topic 2: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 3: Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules |
| Topic 4: Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments |
| Topic 5: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Topic 6: Types of Insurance | 21% | - Third-party liability - Commercial payers - Medicare, Medigap, Medicaid - Managed care plans - TRICARE/CHAMPUS, Workers' compensation |
| Topic 7: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs |
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NEW QUESTION # 177
Case law is also common law; based on a court decision that establishes a precedent.
Answer: B
NEW QUESTION # 178
837
Answer: C
NEW QUESTION # 179
What does HA stand for?
Answer: C
NEW QUESTION # 180
What does AHFS stand for?
Answer: C
NEW QUESTION # 181
CHAMPUS stands for Civilian Health and Medical Program of Veterans Affairs.
Answer: B
NEW QUESTION # 182
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