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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Third-party liability - Commercial payers |
| Topic 2: Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Topic 3: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management - Patient statements, collections |
| Topic 4: Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPTยฎ, HCPCS Level II - Code validation, modifiers |
| Topic 5: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Incident-to billing, global packages - Payer payment policies |
| Topic 6: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs |
| Topic 7: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses |
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NEW QUESTION # 113
What does AHA stand for?
Answer: A
NEW QUESTION # 114
What does BC stand for?
Answer: D
NEW QUESTION # 115
FMAP stands for Federal Medical Assistance Percentage.
Answer: B
NEW QUESTION # 116
fore
Answer: D
NEW QUESTION # 117
HRA stands for Health Reimbursement Arrangement.
Answer: B
NEW QUESTION # 118
......
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