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| Section | Weight | Objectives |
|---|---|---|
| Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| HIPAA and Compliance | 9% | - Compliance programs - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Managed care plans |
| Claims and Billing | 14% | - Denials, appeals, corrections - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses |
| Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments |
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NEW QUESTION # 19
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 # 20
CSCP
Answer: B
NEW QUESTION # 21
What does the acronym DSM stand for?
Answer: D
NEW QUESTION # 22
Which part of the body does crani refer to?
Answer: C
NEW QUESTION # 23
DRG
Answer: D
NEW QUESTION # 24
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