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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion |
| Topic 2: Claims and Billing | 14% | - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
| Topic 3: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Topic 4: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Third-party liability - Commercial payers - Medicare, Medigap, Medicaid |
| Topic 5: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| Topic 6: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 7: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Patient statements, collections - Accounts receivable management - Payment posting, adjustments |
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NEW QUESTION # 211
CDAC stands for Clinical Data Abstracting Center.
Answer: A
NEW QUESTION # 212
Case manager submits written confirmation, authorizing treatment, to provider.
Answer: A
NEW QUESTION # 213
Accounts Receivable Management
Answer: A
NEW QUESTION # 214
hemi
Answer: C
NEW QUESTION # 215
Adverse Effect is also called adverse reaction; the appearance of a pathologic condition due to ingestion r exposure to a chemical substance properly administered or taken.
Answer: A
NEW QUESTION # 216
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