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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 2: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 3: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Commercial payers - Third-party liability |
| Topic 4: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs |
| Topic 5: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Accounts receivable management - Refunds, payment plans, write-offs |
| Topic 6: Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion |
| Topic 7: Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up |
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NEW QUESTION # 219
bronch
Answer: A
NEW QUESTION # 220
What does it mean by inter?
Answer: C
NEW QUESTION # 221
The word root "hema" refers to:
Answer: B
NEW QUESTION # 222
HIPPS stands for Health Insurance Prospective Payment System (code set).
Answer: B
NEW QUESTION # 223
Ambulatory Surgical Center (ASC) includes State Licensed Medicare-certified supplier (not provider) of surgical healthcare services that must accept assignment on Medicare Claims.
Answer: B
NEW QUESTION # 224
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