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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 2: Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 3: Types of Insurance | 21% | - Third-party liability - Managed care plans - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid |
| Topic 4: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs |
| Topic 5: Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Topic 6: Claims and Billing | 14% | - Electronic claims, clearinghouses - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up |
| Topic 7: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages |
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NEW QUESTION # 18
in
Answer: A
NEW QUESTION # 19
Blue Cross Blue Shield Association (BCBSA) is an association of independent Blue Cross Blue Shield plans.
Answer: B
NEW QUESTION # 20
What does AHFS stand for?
Answer: C
NEW QUESTION # 21
Which part of the body does cephal refer to?
Answer: C
NEW QUESTION # 22
iasis
Answer: C
NEW QUESTION # 23
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