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| Section | Weight | Objectives |
|---|---|---|
| Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments |
| Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Third-party liability - Commercial payers - Managed care plans |
| Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Compliance programs - Medical record retention |
| 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 # 185
DOD
Answer: C
NEW QUESTION # 186
FATHOM
Answer: B
NEW QUESTION # 187
Case management services is a process by which an attending physician coordinates and supervises care provided to patient by other providers.
Answer: B
NEW QUESTION # 188
HPSA stands for Health Personnel Shortage Area.
Answer: B
NEW QUESTION # 189
What does it mean by derm and dermat?
Answer: B
NEW QUESTION # 190
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