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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| 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 |
| Types of Insurance | 21% | - Third-party liability - Commercial payers - Medicare, Medigap, Medicaid - Managed care plans - TRICARE/CHAMPUS, Workers' compensation |
| Reimbursement and Collections | 14% | - Patient statements, collections - Accounts receivable management - Refunds, payment plans, write-offs - Payment posting, adjustments |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages |
1. Ambulance Fee Schedule is payment system for ambulance services provided to Medicare Beneficiaries.
A) TRUE
B) FALSE
2. What does AMA stand for?
A) American Medical Association
B) American Management Association
C) American Military Association
3. Adjusted Claim is payment correction resulting in additional payment(s) to the provider.
A) TRUE
B) FALSE
4. bronch
A) bronchial tube
B) neck, cervix
C) head
D) heart
5. FATHOM
A) Federal Employment Compensation Act
B) False Claims Act
C) Fair Debt Collection Practices Act
D) First Look Analysis for Hospital Outlier Monitoring
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: D |
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