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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Topic 2: HIPAA and Compliance | 9% | - Medical record retention - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act |
| Topic 3: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Incident-to billing, global packages - Payer payment policies - CMS-1500, UB-04 completion |
| Topic 4: Reimbursement and Collections | 14% | - Accounts receivable management - Patient statements, collections - Payment posting, adjustments - Refunds, payment plans, write-offs |
| Topic 5: Case Analysis | 17% | - Eligibility verification - Adjudication and resolution - End-to-end billing scenarios |
| Topic 6: Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up - Electronic claims, clearinghouses |
| Topic 7: Types of Insurance | 21% | - Commercial payers - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Managed care plans - Medicare, Medigap, Medicaid |
1. Benefit period (Medicare) __________
A) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 120 consecutive days.
B) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 30 consecutive days.
C) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 60 consecutive days.
D) begins with the first day of hospitalization and ends when the patient has been out of the hospital for 90 consecutive days.
2. ilio
A) in, into, not
B) between
C) within, into
D) ilium (hip bone)
3. DRG
A) Disproportionate share hospital (adjustment)
B) Diagnostic and statistical manual
C) Diagnosis related groups
D) (California) Employment Development Department
4. The medical prefix "ab-" means:
A) abdomen
B) toward
C) extremities, top
D) away from
5. The medical prefixes "a-" and "an-" mean:
A) abdomen
B) extremities, top
C) away from
D) no, not
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: D | Question # 3 Answer: C | Question # 4 Answer: D | Question # 5 Answer: D |
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