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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: HIPAA and Compliance | 9% | - Compliance programs - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards |
| Topic 2: Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies |
| Topic 3: Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up |
| Topic 4: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 5: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 6: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 7: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Managed care plans - Medicare, Medigap, Medicaid |
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NEW QUESTION # 93
Catastrophic cap benefit protects TRICARE beneficiaries form devastating financial loss due to serious illness or long-term treatment by establishing limits over which payments is not required.
Answer: A
NEW QUESTION # 94
837
Answer: B
NEW QUESTION # 95
What does CDHS stand for?
Answer: A
NEW QUESTION # 96
BCBSA stands for Blue Cross Blue Shield Association.
Answer: A
NEW QUESTION # 97
Accounts Receivable Management
Answer: A
NEW QUESTION # 98
......
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