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| Section | Weight | Objectives |
|---|---|---|
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Commercial payers - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Managed care plans |
| HIPAA and Compliance | 9% | - Medical record retention - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Compliance programs |
| Claims and Billing | 14% | - Timely filing rules - Electronic claims, clearinghouses - Claim submission, tracking, follow-up - Denials, appeals, corrections |
| Reimbursement and Collections | 14% | - Patient statements, collections - Refunds, payment plans, write-offs - Payment posting, adjustments - Accounts receivable management |
| Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| Billing Regulations | 13% | - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
1. Which document is mailed by the payer to the patient to illustrate the reimbrsement amount of a covered benefit?
A) Hold Harmless Clause
B) Centers of Medicare and Medicaid Services150 (CMS1500)
C) Explanation of Benefits
D) Health Insurance Claim
2. CAT stands for Computerized Axial Tomography.
A) TRUE
B) FALSE
3. BlueCard Program is program that allows BCBS subscribers to receive local Blue Plan healthcare benefits while traveling or living outside of their plan's area.
A) TRUE
B) FALSE
4. HIPPS stands for Health Insurance Prospective Payment System (code set).
A) TRUE
B) FALSE
5. What is the provider's responsibility when a patient has a copayment?
A) Write it off automatically
B) Bill it to insurance
C) Waive it routinely
D) Collect it at the time of service
Solutions:
| Question # 1 Answer: C | Question # 2 Answer: A | Question # 3 Answer: A | Question # 4 Answer: A | Question # 5 Answer: D |
Certified Professional Biller (CPB)
Over 58266+ Satisfied Customers
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