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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Commercial payers - Medicare, Medigap, Medicaid |
| Topic 2: Claims and Billing | 14% | - Denials, appeals, corrections - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses |
| Topic 3: Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Topic 4: Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 5: Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Topic 6: Reimbursement and Collections | 14% | - Patient statements, collections - Accounts receivable management - Refunds, payment plans, write-offs - Payment posting, adjustments |
| Topic 7: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Compliance programs - Medical record retention |
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NEW QUESTION # 123
What does it mean by cyan?
Answer: C
NEW QUESTION # 124
CLIA
Answer: B
NEW QUESTION # 125
What document is used to transfer patient financial responsibility after insurance adjudication?
Answer: C
Explanation:
A patient statement reflects remaining balances after insurance processing.
NEW QUESTION # 126
What is the primary purpose of National Correct Coding Initiative (NCCI) edits?
Answer: D
Explanation:
NCCI edits prevent unbundling and inappropriate coding combinations.
NEW QUESTION # 127
HCPCS stands for Healthcare Common Procedure Coding System.
Answer: A
NEW QUESTION # 128
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