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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Patient statements, collections - Accounts receivable management - Payment posting, adjustments |
| Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections |
| Types of Insurance | 21% | - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Managed care plans - Medicare, Medigap, Medicaid |
| Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers |
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NEW QUESTION # 146
contra
Answer: B
NEW QUESTION # 147
EFT
Answer: C
NEW QUESTION # 148
Which term refers to a digital version of a patient's paper chart, encompassing a comprehensive record of patient health information?
Answer: B
NEW QUESTION # 149
CA refers to Cancer or Carcinoma.
Answer: B
NEW QUESTION # 150
What does GEM stand for?
Answer: D
NEW QUESTION # 151
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