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| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPTยฎ, HCPCS Level II |
| HIPAA and Compliance | 9% | - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Compliance programs |
| Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Medicare, Medigap, Medicaid - Third-party liability |
| Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments |
| Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up |
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NEW QUESTION # 142
Blue Shield (BS) __________
Answer: A
NEW QUESTION # 143
Case law is also common law; based on a court decision that establishes a precedent.
Answer: B
NEW QUESTION # 144
CRI
Answer: C
NEW QUESTION # 145
BlueCard Program is program that allows BCBS subscribers to receive local Blue Plan healthcare benefits while traveling or living outside of their plan's area.
Answer: B
NEW QUESTION # 146
The medical word root "ileo" refers to the:
Answer: C
NEW QUESTION # 147
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