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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Medical record retention - Privacy, security, transaction standards |
| Topic 2: Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Topic 3: Reimbursement and Collections | 14% | - Patient statements, collections - Accounts receivable management - Refunds, payment plans, write-offs - Payment posting, adjustments |
| Topic 4: Billing Regulations | 13% | - Incident-to billing, global packages - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion |
| Topic 5: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 6: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Third-party liability - Commercial payers - Managed care plans - TRICARE/CHAMPUS, Workers' compensation |
| Topic 7: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
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NEW QUESTION # 122
What is accreditation?
Answer: A
NEW QUESTION # 123
What does it mean by derm and dermat?
Answer: B
NEW QUESTION # 124
The medical word root "hemat" or "hemat/o" refers to:
Answer: D
NEW QUESTION # 125
Which part of the body does genit refer to?
Answer: D
NEW QUESTION # 126
di
Answer: C
NEW QUESTION # 127
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