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| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - Payer payment policies - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management - Payment posting, adjustments |
| HIPAA and Compliance | 9% | - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Compliance programs |
| Claims and Billing | 14% | - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
| Types of Insurance | 21% | - Managed care plans - Medicare, Medigap, Medicaid - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability |
| Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
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NEW QUESTION # 70
HCF stands for Healthcare Finder.
Answer: B
NEW QUESTION # 71
Advance Beneficiary Notice (ABN) is document that acknowledges patient responsibility for payment if Medicare denies the claim.
Answer: B
NEW QUESTION # 72
Which situation is considered billing fraud?
Answer: B
Explanation:
Billing for services not provided is considered fraudulent activity.
NEW QUESTION # 73
Which is the universal claim form used by physicians offices?
Answer: C
NEW QUESTION # 74
HIPPS stands for Health Insurance Prospective Payment System (code set).
Answer: B
NEW QUESTION # 75
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