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| Section | Weight | Objectives |
|---|---|---|
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Types of Insurance | 21% | - Managed care plans - Medicare, Medigap, Medicaid - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Commercial payers |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management - Patient statements, collections |
| Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up - Timely filing rules |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Compliance programs - Medical record retention |
| Billing Regulations | 13% | - CMS-1500, UB-04 completion - Incident-to billing, global packages - Payer payment policies - ACOs, NCCI, LCDs, NCDs |
1. arthr
A) condition
B) two
C) joint
2. HAVEN stands for Home Assessment Validation and Entry.
A) FALSE
B) TRUE
3. Which is a professional member of the healthcare team who provides services or supplies to the insured?
A) Independent Contractor
B) Healthcare Provider
C) Health Insurance Specialist
4. Which part of the body does cervic refer to?
A) vagina
B) neck
C) head
D) skull
5. The medical word root "fibr" or "fibr/o" refers to:
A) fiber
B) milk
C) before
D) stomach
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: B | Question # 3 Answer: B | Question # 4 Answer: B | Question # 5 Answer: A |
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