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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Topic 2: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 3: Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Managed care plans - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Commercial payers |
| Topic 4: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
| Topic 5: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Topic 6: Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages |
| Topic 7: Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up - Timely filing rules |
1. Birthday rule determines coverage by primary and secondary policies when each parent subscribes to a different health insurance plan.
A) TRUE
B) FALSE
2. DMEPOS
A) Diagnosis related groups
B) Department of Defense
C) Durable Medical Equipment regional carriers
D) Durable Medical Equipment, Prosthetic and Orthotic Supplies
3. Which part of the body does cephal refer to?
A) head
B) neck
C) heart
D) vagina
4. What does it mean by cry?
A) warm
B) cold
C) cool
D) hot
5. Catchment area is the region defined by code boundaries within a 40mile radius of a military treatment facility.
A) TRUE
B) FALSE
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: D | Question # 3 Answer: A | Question # 4 Answer: B | Question # 5 Answer: A |
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