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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act |
| Topic 2: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages |
| Topic 3: Types of Insurance | 21% | - Managed care plans - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Commercial payers |
| Topic 4: Reimbursement and Collections | 14% | - Patient statements, collections - Accounts receivable management - Payment posting, adjustments - Refunds, payment plans, write-offs |
| Topic 5: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Topic 6: Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPTยฎ, HCPCS Level II - Code validation, modifiers |
| Topic 7: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules |
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NEW QUESTION # 131
CPT
Answer: C
NEW QUESTION # 132
Which part of the body does crani refer to?
Answer: B
NEW QUESTION # 133
What is accreditation?
Answer: A
NEW QUESTION # 134
HSA stands for Health Savings account.
Answer: A
NEW QUESTION # 135
The medical word root "ankyl/o" (or "ankyl") means:
Answer: B
NEW QUESTION # 136
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