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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - Payer payment policies - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - CMS-1500, UB-04 completion |
| Topic 2: HIPAA and Compliance | 9% | - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards |
| Topic 3: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Topic 4: Reimbursement and Collections | 14% | - Patient statements, collections - Accounts receivable management - Refunds, payment plans, write-offs - Payment posting, adjustments |
| Topic 5: Types of Insurance | 21% | - Managed care plans - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Commercial payers |
| Topic 6: Claims and Billing | 14% | - Timely filing rules - Claim submission, tracking, follow-up - Denials, appeals, corrections - Electronic claims, clearinghouses |
| Topic 7: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
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NEW QUESTION # 217
Carcinoma (Ca) in situ is a malignant tumor that is localized, circumscribed, encapsulated, and noninvasive (has not spread to deeper or adjacent tissues or organs).
Answer: A
NEW QUESTION # 218
What is All Patient DiagnosisRelated Group (APDRG)?
Answer: B
NEW QUESTION # 219
EGHP
Answer: A
NEW QUESTION # 220
What does ANSI stand for?
Answer: A
NEW QUESTION # 221
FPL
Answer: B
NEW QUESTION # 222
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