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| Section | Weight | Objectives |
|---|---|---|
| Types of Insurance | 21% | - TRICARE/CHAMPUS, Workers' compensation - Third-party liability - Commercial payers - Medicare, Medigap, Medicaid - Managed care plans |
| Coding Concepts for Billers | 12% | - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II - Medical necessity |
| Case Analysis | 17% | - Adjudication and resolution - Eligibility verification - End-to-end billing scenarios |
| HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Compliance programs - Fraud, abuse, False Claims Act - Medical record retention |
| Claims and Billing | 14% | - Timely filing rules - Denials, appeals, corrections - Claim submission, tracking, follow-up - Electronic claims, clearinghouses |
| Billing Regulations | 13% | - ACOs, NCCI, LCDs, NCDs - Payer payment policies - Incident-to billing, global packages - CMS-1500, UB-04 completion |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Refunds, payment plans, write-offs - Patient statements, collections - Accounts receivable management |
1. What does AHIMA stand for?
A) American Health Information Management Association
B) African Health Information Management Association
C) Australian Health Information Management Association
D) Asian Health Information Management Association
2. FEP stands for Federal Employee Program.
A) FALSE
B) TRUE
3. DME
A) Department of Defense
B) Durable Medical Equipment regional carriers
C) Durable Medical Equipment, Prosthetic and Orthotic Supplies
D) Durable Medical Equipment
4. Who is a person who performs services for another under an expressed or implied agreement?
A) Healthcare Provider
B) Independent Contractor
C) Health Insurance Specialist
5. What is Ambulatory Surgical Center Payment Rate?
A) Determined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
B) Predetermined amount for which ASC services are reimbursed, at 80 percent after adjustment for regional wage variations.
C) Determined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
D) Predetermined amount for which ASC services are reimbursed, at 80 percent before adjustment for regional wage variations.
Solutions:
| Question # 1 Answer: A | Question # 2 Answer: B | Question # 3 Answer: D | Question # 4 Answer: B | Question # 5 Answer: B |
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