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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Timely filing rules - Denials, appeals, corrections |
| Topic 2: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 3: Reimbursement and Collections | 14% | - Accounts receivable management - Refunds, payment plans, write-offs - Patient statements, collections - Payment posting, adjustments |
| Topic 4: Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Topic 5: HIPAA and Compliance | 9% | - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Compliance programs |
| Topic 6: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages - CMS-1500, UB-04 completion |
| Topic 7: Types of Insurance | 21% | - Managed care plans - Third-party liability - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid |
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NEW QUESTION # 103
GPWW stands for Group Practice Without Walls.
Answer: B
NEW QUESTION # 104
fore
Answer: B
NEW QUESTION # 105
anti
Answer: C
NEW QUESTION # 106
The medical prefixes "end-" and "endo-" mean:
Answer: C
NEW QUESTION # 107
What does it mean by dextr?
Answer: B
NEW QUESTION # 108
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