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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| Topic 2: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 3: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Medical record retention - Privacy, security, transaction standards |
| Topic 4: Claims and Billing | 14% | - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules |
| Topic 5: Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Topic 6: Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Medicare, Medigap, Medicaid - Commercial payers |
| Topic 7: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
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NEW QUESTION # 197
What does it mean by dextr?
Answer: A
NEW QUESTION # 198
CDAC stands for Clinical Data Abstracting Center.
Answer: B
NEW QUESTION # 199
What does APC stand for?
Answer: D
NEW QUESTION # 200
What does it mean by gyn, gyne and gynec?
Answer: A
NEW QUESTION # 201
Preauthorization is an authorization that must be received from a payer before treatment by a specialist will be covered.
Answer: B
NEW QUESTION # 202
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