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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Reimbursement and Collections | 14% | - Payment posting, adjustments - Accounts receivable management - Refunds, payment plans, write-offs - Patient statements, collections |
| Topic 2: Claims and Billing | 14% | - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up - Electronic claims, clearinghouses |
| Topic 3: HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Topic 4: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies |
| Topic 5: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Managed care plans - Third-party liability - Commercial payers |
| Topic 6: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 7: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
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NEW QUESTION # 15
Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?
Answer: C
NEW QUESTION # 16
What does CDT stand for?
Answer: B
NEW QUESTION # 17
Capitation
Answer: A
NEW QUESTION # 18
What is All Patient Refined DiagnosisRelated Group (ARPDRG)?
Answer: B
NEW QUESTION # 19
DME
Answer: C
NEW QUESTION # 20
......
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