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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Topic 2: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs - Privacy, security, transaction standards |
| Topic 3: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 4: Billing Regulations | 13% | - Payer payment policies - Incident-to billing, global packages - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs |
| Topic 5: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
| Topic 6: Reimbursement and Collections | 14% | - Patient statements, collections - Payment posting, adjustments - Accounts receivable management - Refunds, payment plans, write-offs |
| Topic 7: Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Commercial payers - Third-party liability |
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NEW QUESTION # 191
Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.
Answer: A
NEW QUESTION # 192
What does AHA stand for?
Answer: D
NEW QUESTION # 193
Case management is development of patient care plans to coordinate and provide care for complicated cases in a cost effective manner.
Answer: A
NEW QUESTION # 194
CHAMPUS stands for Civilian Health and Medical Program of Veterans Affairs.
Answer: A
NEW QUESTION # 195
Adjudication
Answer: D
NEW QUESTION # 196
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