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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Managed care plans - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Commercial payers |
| Topic 2: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
| Topic 3: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections |
| Topic 4: Reimbursement and Collections | 14% | - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 5: Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Topic 6: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| Topic 7: Billing Regulations | 13% | - CMS-1500, UB-04 completion - Incident-to billing, global packages - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
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NEW QUESTION # 101
Blue Cross Blue Shield Association (BCBSA) is an association of independent Blue Cross Blue Shield plans.
Answer: A
NEW QUESTION # 102
What does BS stand for?
Answer: B
NEW QUESTION # 103
Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?
Answer: A
NEW QUESTION # 104
What does GEM stand for?
Answer: C
NEW QUESTION # 105
What does CF stand for?
Answer: D
NEW QUESTION # 106
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