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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 2: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Commercial payers - Managed care plans |
| Topic 3: Reimbursement and Collections | 14% | - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 4: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act - Medical record retention |
| Topic 5: Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up - Timely filing rules |
| Topic 6: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 7: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages |
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NEW QUESTION # 139
What does HIPAA stand for?
Answer: B
NEW QUESTION # 140
CPT
Answer: C
NEW QUESTION # 141
EOB
Answer: D
NEW QUESTION # 142
Which of the following suffixes means half?
Answer: B
NEW QUESTION # 143
Bonding insurance is an insurance agreement that guarantees repayment for financial losses resulting from the act or failure to act of an employee. It protects the financial operations of the employer.
Answer: A
NEW QUESTION # 144
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