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| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion |
| Claims and Billing | 14% | - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| HIPAA and Compliance | 9% | - Compliance programs - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Medical record retention |
| Types of Insurance | 21% | - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Medicare, Medigap, Medicaid - Commercial payers |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs |
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NEW QUESTION # 107
What does it mean by galact and lact?
Answer: A
NEW QUESTION # 108
Which term means the patient is not responsible for paying for what the insurance plan denies?
Answer: B
NEW QUESTION # 109
What does AMA stand for?
Answer: C
NEW QUESTION # 110
HAVEN stands for Home Assessment Validation and Entry.
Answer: B
NEW QUESTION # 111
HPSA stands for Health Personnel Shortage Area.
Answer: B
NEW QUESTION # 112
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