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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity - Code validation, modifiers |
| Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Denials, appeals, corrections - Timely filing rules - Electronic claims, clearinghouses |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies |
| Types of Insurance | 21% | - Managed care plans - Medicare, Medigap, Medicaid - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Commercial payers |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
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NEW QUESTION # 140
HICN stands for Health Insurance claim number.
Answer: A
NEW QUESTION # 141
Catastrophic cap benefit protects TRICARE beneficiaries form devastating financial loss due to serious illness or long-term treatment by establishing limits over which payments is not required.
Answer: A
NEW QUESTION # 142
APDRG refers to All Patient DiagnosisRelated Group.
Answer: A
NEW QUESTION # 143
BlueCard Program is program that allows BCBS subscribers to receive local Blue Plan healthcare benefits while traveling or living outside of their plan's area.
Answer: A
NEW QUESTION # 144
Amendment to the HMO Act of 1973 is legislation that allowed federally qualified HMOs to permit members to occasionally use non HMO physicians and be partially reimbursed.
Answer: A
NEW QUESTION # 145
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