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| Section | Weight | Objectives |
|---|---|---|
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Managed care plans |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act - Medical record retention |
| Reimbursement and Collections | 14% | - Accounts receivable management - Refunds, payment plans, write-offs - Payment posting, adjustments - Patient statements, collections |
| Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections |
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NEW QUESTION # 227
What does the acronym E/M stand for in medical coding?
Answer: D
NEW QUESTION # 228
Which situation is considered billing fraud?
Answer: A
Explanation:
Billing for services not provided is considered fraudulent activity.
NEW QUESTION # 229
abdomin
Answer: A
NEW QUESTION # 230
Which part of the body does cardi refer to?
Answer: D
NEW QUESTION # 231
EPO
Answer: B
NEW QUESTION # 232
......
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