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| Section | Weight | Objectives |
|---|---|---|
| Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - CMS-1500, UB-04 completion - Payer payment policies |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPTยฎ, HCPCS Level II - Medical necessity |
| Types of Insurance | 21% | - Commercial payers - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Medicare, Medigap, Medicaid |
| Case Analysis | 17% | - End-to-end billing scenarios - Adjudication and resolution - Eligibility verification |
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Medical record retention - Compliance programs |
| Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
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NEW QUESTION # 200
HEDIS stands for Health Plan Employer Data and Information Set.
Answer: A
NEW QUESTION # 201
EGHP
Answer: A
NEW QUESTION # 202
What does it mean by intra and intro?
Answer: B
NEW QUESTION # 203
What does it mean by benign?
Answer: B
NEW QUESTION # 204
de
Answer: C
NEW QUESTION # 205
......
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