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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Topic 2: Claims and Billing | 14% | - Denials, appeals, corrections - Electronic claims, clearinghouses - Timely filing rules - Claim submission, tracking, follow-up |
| Topic 3: Billing Regulations | 13% | - Incident-to billing, global packages - Payer payment policies - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs |
| Topic 4: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
| Topic 5: Types of Insurance | 21% | - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Managed care plans - Commercial payers |
| Topic 6: Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments |
| Topic 7: HIPAA and Compliance | 9% | - Medical record retention - Compliance programs - Privacy, security, transaction standards - Fraud, abuse, False Claims Act |
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NEW QUESTION # 56
HSSA stands for Health Savings Security Account.
Answer: A
NEW QUESTION # 57
CA refers to Cancer or Carcinoma.
Answer: A
NEW QUESTION # 58
APDRG refers to All Patient DiagnosisRelated Group.
Answer: A
NEW QUESTION # 59
COBRA
Answer: B
NEW QUESTION # 60
The medical word root "eti" (or "eti/o") refers to:
Answer: C
NEW QUESTION # 61
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