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| Section | Weight | Objectives |
|---|---|---|
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - Payer payment policies - CMS-1500, UB-04 completion |
| HIPAA and Compliance | 9% | - Compliance programs - Medical record retention - Fraud, abuse, False Claims Act - Privacy, security, transaction standards |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Types of Insurance | 21% | - Third-party liability - Managed care plans - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid - Commercial payers |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments |
1. 837
A) Claims validation table (as in ANSI ASC X12 837)
B) Claims validation table (as in ANSI ASC X11 837)
C) Claims validation table (as in ANSI ASC X13 837)
D) Claims validation table (as in ANSI ASC X10 837)
2. What does BSR stand for?
A) Black Shield Representative
B) Beneficiary Services Representative
C) Beneficiary Standards Representative
D) Blue Shield Representative
3. Which is a professional member of the healthcare team who provides services or supplies to the insured?
A) Healthcare Provider
B) Health Insurance Specialist
C) Independent Contractor
4. Which situation is considered billing fraud?
A) Billing for services not rendered
B) Typographical error on a claim
C) Appealing a denied claim
D) Late claim submission
5. What does it mean by dextr?
A) right
B) left
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: B | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: A |
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