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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards - Medical record retention |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers |
| Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments - Patient statements, collections |
| Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Third-party liability - Medicare, Medigap, Medicaid |
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NEW QUESTION # 146
Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?
Answer: C
NEW QUESTION # 147
Which of the following suffixes refers to in?
Answer: C
NEW QUESTION # 148
Which professional association was founded to improve the quality of medical records and current advances toward an electronic and global environment including the implementation of ICD10CM
Answer: C
NEW QUESTION # 149
HRA stands for Health Reimbursement Arrangement.
Answer: B
NEW QUESTION # 150
CAT stands for Computerized Axial Tomography.
Answer: B
NEW QUESTION # 151
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