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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 2: Billing Regulations | 13% | - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Topic 3: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Medical record retention - Compliance programs |
| Topic 4: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 5: Types of Insurance | 21% | - Third-party liability - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Commercial payers |
| Topic 6: Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up |
| Topic 7: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Patient statements, collections - Accounts receivable management |
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NEW QUESTION # 51
What does it mean by dacry?
Answer: B
NEW QUESTION # 52
What does the acronym COB stand for in medical billing?
Answer: D
NEW QUESTION # 53
Who is the person who prepares and reviews claims for accuracy to ensure prompt payment?
Answer: B
NEW QUESTION # 54
What does it mean by ipsi?
Answer: B
NEW QUESTION # 55
HIPPS stands for Health Insurance Prospective Payment System (code set).
Answer: B
NEW QUESTION # 56
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