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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion |
| Topic 2: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Denials, appeals, corrections - Electronic claims, clearinghouses - Timely filing rules |
| Topic 3: Reimbursement and Collections | 14% | - Payment posting, adjustments - Refunds, payment plans, write-offs - Patient statements, collections - Accounts receivable management |
| Topic 4: Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Topic 5: Types of Insurance | 21% | - Third-party liability - Commercial payers - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid |
| Topic 6: Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 7: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
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NEW QUESTION # 241
What is Ambulatory Surgical Center Payment Rate?
Answer: C
NEW QUESTION # 242
When is an Advance Beneficiary Notice (ABN) required?
Answer: A
Explanation:
An ABN informs Medicare patients that they may be financially responsible if coverage is denied.
NEW QUESTION # 243
What is the primary purpose of a compliance program in a medical billing office?
Answer: C
Explanation:
Compliance programs help prevent improper billing, fraud, and regulatory violations.
NEW QUESTION # 244
HRA stands for Health Reimbursement Arrangement.
Answer: A
NEW QUESTION # 245
HSA stands for Health Savings account.
Answer: A
NEW QUESTION # 246
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