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| Section | Weight | Objectives |
|---|---|---|
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Medicare, Medigap, Medicaid - Third-party liability |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections |
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NEW QUESTION # 44
What does AMA stand for?
Answer: A
NEW QUESTION # 45
Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?
Answer: A
NEW QUESTION # 46
What does CDHS stand for?
Answer: B
NEW QUESTION # 47
EQRO
Answer: B
NEW QUESTION # 48
CHAMPUS stands for Civilian Health and Medical Program of Veterans Affairs.
Answer: A
NEW QUESTION # 49
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