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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Commercial payers - Managed care plans |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages |
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NEW QUESTION # 34
Blue Cross Blue Shield (BCBS) is joint venture between Blue Cross and Blue Shield where the corporation shared one building and computer.
Answer: A
NEW QUESTION # 35
The medical prefix "dys-" means:
Answer: A
NEW QUESTION # 36
Which of the following suffixes means half?
Answer: C
NEW QUESTION # 37
BCAC stands for Beneficiary Counseling and Assistance Coordinator.
Answer: A
NEW QUESTION # 38
What does the acronym EHR stand for?
Answer: B
NEW QUESTION # 39
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