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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Patient statements, collections - Payment posting, adjustments - Accounts receivable management |
| Topic 2: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 3: Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| Topic 4: Billing Regulations | 13% | - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
| Topic 5: Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
| Topic 6: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards - Medical record retention |
| Topic 7: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Managed care plans - Medicare, Medigap, Medicaid - Commercial payers |
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NEW QUESTION # 144
Which part of the body does cephal refer to?
Answer: A
NEW QUESTION # 145
What does ADA stand for?
Answer: C
NEW QUESTION # 146
What does HMO stand for?
Answer: B
NEW QUESTION # 147
Accounts Receivable Aging Report
Answer: C
NEW QUESTION # 148
Which payer typically requires prior authorization for certain services?
Answer: D
Explanation:
Commercial and managed care plans frequently require prior authorization.
NEW QUESTION # 149
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