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| Section | Weight | Objectives |
|---|---|---|
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Claims and Billing | 14% | - Denials, appeals, corrections - Timely filing rules - Claim submission, tracking, follow-up - Electronic claims, clearinghouses |
| HIPAA and Compliance | 9% | - Medical record retention - Fraud, abuse, False Claims Act - Compliance programs - Privacy, security, transaction standards |
| Types of Insurance | 21% | - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Medicare, Medigap, Medicaid - Managed care plans |
| 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 - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Accounts receivable management - Patient statements, collections - Payment posting, adjustments |
Who is a person who performs services for another under an expressed or implied agreement?
Correct Answer: B 🗳️
What does APC stand for?
Correct Answer: A 🗳️
What does it mean by graphy?
Correct Answer: B 🗳️
What does AAMA stand for?
Correct Answer: D 🗳️
The medical prefix "infra-" means:
Correct Answer: D 🗳️
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