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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Compliance programs - Medical record retention |
| Topic 2: Billing Regulations | 13% | - Incident-to billing, global packages - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion |
| Topic 3: Claims and Billing | 14% | - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules |
| Topic 4: Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPTยฎ, HCPCS Level II |
| Topic 5: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 6: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Commercial payers - Third-party liability - Medicare, Medigap, Medicaid |
| Topic 7: Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments |
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NEW QUESTION # 182
ASC (Choose two.)
Answer: C,D
NEW QUESTION # 183
Ambulatory Surgical Center (ASC) includes State Licensed Medicare-certified supplier (not provider) of surgical healthcare services that must accept assignment on Medicare Claims.
Answer: B
NEW QUESTION # 184
FMAP stands for Federal Medical Assistance Percentage.
Answer: B
NEW QUESTION # 185
The medical word root "hyster" or "hyster/o" refers to the:
Answer: B
NEW QUESTION # 186
What does it mean by derm and dermat?
Answer: C
NEW QUESTION # 187
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