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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Third-party liability - Managed care plans |
| Topic 2: Claims and Billing | 14% | - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up |
| Topic 3: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 4: Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
| Topic 5: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Accounts receivable management - Refunds, payment plans, write-offs |
| Topic 6: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs |
| 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 # 31
The medical word root "hepat" or "hepat/o" refers to the:
Answer: B
NEW QUESTION # 32
What does it mean by cry?
Answer: A
NEW QUESTION # 33
Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.
Answer: B
NEW QUESTION # 34
What is Allowed Charge?
Answer: A
NEW QUESTION # 35
contra
Answer: B
NEW QUESTION # 36
......
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