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| Section | Weight | Objectives |
|---|---|---|
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPTยฎ, HCPCS Level II |
| Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Managed care plans - Medicare, Medigap, Medicaid |
| HIPAA and Compliance | 9% | - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up - Electronic claims, clearinghouses |
| Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Billing Regulations | 13% | - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
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NEW QUESTION # 15
FELA stands for Federal Employment Liability Act.
Answer: B
NEW QUESTION # 16
Which professional association was founded to elevate the standards of medical coding by providing certification, ongoing education, networking, and recognition for coders?
Answer: A
NEW QUESTION # 17
CAC (Choose two.)
Answer: C,D
NEW QUESTION # 18
What is the coding system currently in use to report diagnoses and reasons for encounter?
Answer: C
NEW QUESTION # 19
What does it mean by adip?
Answer: B
NEW QUESTION # 20
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