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| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Incident-to billing, global packages - Payer payment policies |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management - Patient statements, collections |
| Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up |
| Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Managed care plans - Third-party liability |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs |
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NEW QUESTION # 32
Which amount is written off when a provider is contracted with an insurance company?
Answer: A
Explanation:
Contractual adjustments are the differences between billed charges and allowed amounts.
NEW QUESTION # 33
BCBSA stands for Blue Cross Blue Shield Association.
Answer: B
NEW QUESTION # 34
EOB
Answer: A
NEW QUESTION # 35
DME
Answer: B
NEW QUESTION # 36
Which of the following suffixes does NOT mean blood?
Answer: B
NEW QUESTION # 37
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