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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Compliance programs - Fraud, abuse, False Claims Act - Medical record retention - Privacy, security, transaction standards |
| Types of Insurance | 21% | - Medicare, Medigap, Medicaid - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Managed care plans |
| Billing Regulations | 13% | - Payer payment policies - CMS-1500, UB-04 completion - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Patient statements, collections - Accounts receivable management |
| Case Analysis | 17% | - End-to-end billing scenarios - Eligibility verification - Adjudication and resolution |
| Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up - Electronic claims, clearinghouses |
Question 1
The medical prefix "ab-" means:
A. abdomen
B. extremities, top
C. away from
D. toward
Question 2
FEP stands for Federal Employee Program.
A. TRUE
B. FALSE
Question 3
HPSA stands for Health Personnel Shortage Area.
A. TRUE
B. FALSE
Question 4
What does the acronym CT stand for?
A. Debt Collection Assistance Officer
B. Durable Medical Equipment
C. Computed Tomography
D. Defense Enrollment Eligibility Reporting System
Question 5
What is All Patient DiagnosisRelated Group (APDRG)?
A. Adopted by Medicare in 2008 to reimburse hospitals for inpatient care provided to Medicare beneficiaries; expanded original DRG system (based on intensity of resources) to add two subclasses to each DRG that adjusts Medicare inpatient hospital reimbursement rates for severity of illness (SOI) (extent of physiological decompensation or organ system loss of function) and risk of mortality (ROM) (likelihood of dying); each subclass, in turn, is subdivided into four areas: (1) minor, (2) moderate, (3) major, (4) extreme.
B. DRG system adapted for use by third-party payers to reimburse hospitals for inpatient care provided to nonMedicare beneficiaries (e.g. Blue Cross BlueShield, commercial health plans, TRICARE); DRG assignment is based on intensity of resources.
Solutions:
| Question 1 Answer: C | Question 2 Answer: A | Question 3 Answer: A | Question 4 Answer: C | Question 5 Answer: B |
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