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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Topic 2: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 3: Types of Insurance | 21% | - Managed care plans - Commercial payers - Medicare, Medigap, Medicaid - Third-party liability - TRICARE/CHAMPUS, Workers' compensation |
| Topic 4: Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Topic 5: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 6: HIPAA and Compliance | 9% | - Medical record retention - Compliance programs - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Topic 7: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
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NEW QUESTION # 28
Billing entity is the legal business name of the provider's practice.
Answer: A
NEW QUESTION # 29
CNS
Answer: B
NEW QUESTION # 30
What are actions inconsistent with accepted, sound medical business or fiscal practice?
Answer: B
NEW QUESTION # 31
The medical word root "eti" (or "eti/o") refers to:
Answer: B
NEW QUESTION # 32
The word root "hema" refers to:
Answer: C
NEW QUESTION # 33
......
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