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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages |
| Topic 2: Case Analysis | 17% | - Eligibility verification - End-to-end billing scenarios - Adjudication and resolution |
| Topic 3: Reimbursement and Collections | 14% | - Payment posting, adjustments - Patient statements, collections - Refunds, payment plans, write-offs - Accounts receivable management |
| Topic 4: HIPAA and Compliance | 9% | - Medical record retention - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act |
| Topic 5: Claims and Billing | 14% | - Electronic claims, clearinghouses - Denials, appeals, corrections - Claim submission, tracking, follow-up - Timely filing rules |
| Topic 6: Types of Insurance | 21% | - Managed care plans - Third-party liability - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid |
| Topic 7: Coding Concepts for Billers | 12% | - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers |
1. CRI
A) Computed Tomography
B) Customized SubCapitation Plan
C) CHAMPUS Reform Initiative
D) Debt Collection Assistance Officer
2. HRA stands for Health Reimbursement Arrangement.
A) TRUE
B) FALSE
3. Accounts Receivable Management
A) Voluntary Process that a healthcare facility or organization (e.g. hospital or managed care plan) undergoes to demonstrate that it has met standards beyond those required by law.
B) Judicial dispute resolution process in which an appeals board makes a final determination.
C) Payment correction resulting in additional payment(s) to the provider.
D) Assists providers in the collection of appropriate reimbursement for services rendered; include functions such as insurance verification/eligibility and preauthorization of services
4. What does HIPAA stand for?
A) Health Insurance portability and accountability Act of 1997
B) Health Insurance portability and accountability Act of 1996
C) Health Insurance portability and accountability Act of 1995
D) Health Insurance portability and accountability Act of 1994
5. EGHP
A) Electronic Healthcare Network Accreditation Commission
B) Evaluation and Management
C) Employer group health plan
D) Electronic Health Record
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: A | Question # 3 Answer: D | Question # 4 Answer: B | Question # 5 Answer: C |
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