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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Commercial payers - Third-party liability - Managed care plans - Medicare, Medigap, Medicaid |
| Topic 2: HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards - Compliance programs |
| Topic 3: Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages - CMS-1500, UB-04 completion |
| Topic 4: Reimbursement and Collections | 14% | - Payment posting, adjustments - Refunds, payment plans, write-offs - Accounts receivable management - Patient statements, collections |
| 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 - Electronic claims, clearinghouses - Claim submission, tracking, follow-up |
| Topic 7: Coding Concepts for Billers | 12% | - ICD-10-CM, CPT®, HCPCS Level II - Code validation, modifiers - Medical necessity |
1. extra
A) outside
B) fiber
C) milk
D) before
2. What is the amount owed to a business for services or goods provided?
A) Accounts Receivable
B) Accounts Billing
C) Accrued Revenue
D) Accounts Payable
3. The medical word root "hyster" or "hyster/o" refers to the:
A) uterus, womb
B) pertaining to
C) condition
4. American Association of Medical Assistants (AAMA) enables medical assisting professionals to enhance and demonstrate the knowledge, skills, and professionalism required by employers and patients; as well as protect medical assistants' right to practice.
A) TRUE
B) FALSE
5. What are Category I Codes?
A) Temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field (e.g., 0001T) these codes are located after the Medicine section, and will be archived after five years unless accepted for placement within Category I sections of CPT.
B) Procedures/ services identified by a five digit CPT code and descriptor nomenclature; these codes are traditionally associated with CPT and organized within six sections.
C) Optional performance measurement tracking codes that are assigned an alphanumeric identifier with a letter in the last field (e,g.,1234A); these codes will be located after the medicine section; their use is optional.
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: B |
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