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| Section | Weight | Objectives |
|---|---|---|
| Reimbursement and Collections | 14% | - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management |
| HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Commercial payers - Third-party liability |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
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NEW QUESTION # 124
Which document communicates to the payer that the provider is requesting reimbursement?
Answer: C
NEW QUESTION # 125
What does it mean by graphy?
Answer: A
NEW QUESTION # 126
Which part of the body does cervic refer to?
Answer: C
NEW QUESTION # 127
Birthday rule determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
Answer: A
NEW QUESTION # 128
What does the acronym ERISA stand for?
Answer: A
NEW QUESTION # 129
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