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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Reimbursement and Collections | 14% | - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 2: Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up |
| Topic 3: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Topic 4: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Third-party liability - Commercial payers - Managed care plans - TRICARE/CHAMPUS, Workers' compensation |
| Topic 5: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages |
| 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 # 153
Which document communicates to the payer that the provider is requesting reimbursement?
Answer: C
NEW QUESTION # 154
What does it mean by erythr?
Answer: D
NEW QUESTION # 155
ERA
Answer: A
NEW QUESTION # 156
HHRG stands for Home Health Resource Group.
Answer: A
NEW QUESTION # 157
in
Answer: C
NEW QUESTION # 158
......
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