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| Section | Weight | Objectives |
|---|---|---|
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up |
| HIPAA and Compliance | 9% | - Compliance programs - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention |
| Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Medicare, Medigap, Medicaid - Third-party liability - Commercial payers |
| Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments |
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NEW QUESTION # 51
Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.
Answer: B
NEW QUESTION # 52
EDI
Answer: C
NEW QUESTION # 53
HHRG stands for Home Health Resource Group.
Answer: B
NEW QUESTION # 54
CSCP
Answer: C
NEW QUESTION # 55
Medical Ethics are principles of right or good conduct.
Answer: B
NEW QUESTION # 56
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