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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs - Privacy, security, transaction standards |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Types of Insurance | 21% | - Commercial payers - Medicare, Medigap, Medicaid - Managed care plans - Third-party liability - TRICARE/CHAMPUS, Workers' compensation |
| Claims and Billing | 14% | - Timely filing rules - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Denials, appeals, corrections |
| Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments |
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies |
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NEW QUESTION # 62
Preauthorization is an authorization that must be received from a payer before treatment by a specialist will be covered.
Answer: A
NEW QUESTION # 63
Which amount is written off when a provider is contracted with an insurance company?
Answer: B
Explanation:
Contractual adjustments are the differences between billed charges and allowed amounts.
NEW QUESTION # 64
What does "timely filing" refer to?
Answer: C
Explanation:
Timely filing means submitting claims within the time limits set by the payer.
NEW QUESTION # 65
What does it mean by brachy?
Answer: B
NEW QUESTION # 66
BCBS stands for Blue Cross Blue Shield.
Answer: A
NEW QUESTION # 67
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