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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Topic 2: Billing Regulations | 13% | - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - Payer payment policies |
| Topic 3: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Medicare, Medigap, Medicaid - Managed care plans |
| Topic 4: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act |
| Topic 5: Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers |
| Topic 6: Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Topic 7: Reimbursement and Collections | 14% | - Accounts receivable management - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs |
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NEW QUESTION # 159
Breach of confidentiality is unauthorized release of patient information to third party.
Answer: A
NEW QUESTION # 160
ERA
Answer: D
NEW QUESTION # 161
What does the acronym CT stand for?
Answer: D
NEW QUESTION # 162
Which professional association was founded to improve the quality of medical records and current advances toward an electronic and global environment including the implementation of ICD10CM
Answer: C
NEW QUESTION # 163
CRI
Answer: D
NEW QUESTION # 164
......
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