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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Commercial payers |
| Topic 2: Claims and Billing | 14% | - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up |
| Topic 3: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs - Privacy, security, transaction standards |
| Topic 4: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Accounts receivable management - Refunds, payment plans, write-offs |
| Topic 5: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
| Topic 6: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 7: Billing Regulations | 13% | - CMS-1500, UB-04 completion - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - Payer payment policies |
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NEW QUESTION # 39
Who is the person who prepares and reviews claims for accuracy to ensure prompt payment?
Answer: C
NEW QUESTION # 40
EDD
Answer: D
NEW QUESTION # 41
The medical word root "hemat" or "hemat/o" refers to:
Answer: A
NEW QUESTION # 42
DMERC
Answer: C
NEW QUESTION # 43
Blue Worldwide Expat __________
Answer: A
NEW QUESTION # 44
......
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