Last Updated: Aug 28, 2026
No. of Questions: 245 Questions & Answers with Testing Engine
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| Section | Weight | Objectives |
|---|---|---|
| Topic 1: Coding Concepts for Billers | 12% | - Code validation, modifiers - Medical necessity - ICD-10-CM, CPT®, HCPCS Level II |
| Topic 2: HIPAA and Compliance | 9% | - Privacy, security, transaction standards - Fraud, abuse, False Claims Act - Medical record retention - Compliance programs |
| Topic 3: Billing Regulations | 13% | - CMS-1500, UB-04 completion - Payer payment policies - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs |
| Topic 4: Reimbursement and Collections | 14% | - Refunds, payment plans, write-offs - Payment posting, adjustments - Patient statements, collections - Accounts receivable management |
| Topic 5: Types of Insurance | 21% | - Third-party liability - Managed care plans - Commercial payers - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid |
| Topic 6: Claims and Billing | 14% | - Claim submission, tracking, follow-up - Electronic claims, clearinghouses - Denials, appeals, corrections - Timely filing rules |
| Topic 7: Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
Question 1
The medical word root "hepat" or "hepat/o" refers to the:
A. uterus, womb
B. liver
C. below, under
D. above, excessive
Question 2
What does CF stand for?
A. Clinical Factor
B. Conversion Factor
C. Civilian FactorAffairs
D. Competitive Factor
Question 3
Case manager submits written confirmation, authorizing treatment, to provider.
A. FALSE
B. TRUE
Question 4
A patient has Medicare as primary and a commercial plan as secondary. Which insurance should be billed first?
A. Secondary insurance
B. Commercial insurance
C. Medicaid
D. Medicare
Question 5
Beneficiary counseling and assistance coordinator (BCAC) is individual available at military treatment facility (MTF) to answer questions, help solve healthcare related problems, and assist beneficiaries in obtaining medical care through TRICARE; was previously called health benefits advisor (HBA).
A. FALSE
B. TRUE
Solutions:
| Question 1 Answer: B | Question 2 Answer: B | Question 3 Answer: B | Question 4 Answer: D | Question 5 Answer: B |
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