Last Updated: Sep 08, 2026
No. of Questions: 245 Questions & Answers with Testing Engine
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| Section | Weight | Objectives |
|---|---|---|
| HIPAA and Compliance | 9% | - Fraud, abuse, False Claims Act - Privacy, security, transaction standards - Medical record retention - Compliance programs |
| Billing Regulations | 13% | - Incident-to billing, global packages - ACOs, NCCI, LCDs, NCDs - CMS-1500, UB-04 completion - Payer payment policies |
| Case Analysis | 17% | - Adjudication and resolution - End-to-end billing scenarios - Eligibility verification |
| Types of Insurance | 21% | - Commercial payers - Managed care plans - Third-party liability - TRICARE/CHAMPUS, Workers' compensation - Medicare, Medigap, Medicaid |
| Claims and Billing | 14% | - Claim submission, tracking, follow-up - Timely filing rules - Electronic claims, clearinghouses - Denials, appeals, corrections |
| Coding Concepts for Billers | 12% | - Medical necessity - Code validation, modifiers - ICD-10-CM, CPT®, HCPCS Level II |
| Reimbursement and Collections | 14% | - Payment posting, adjustments - Refunds, payment plans, write-offs - Patient statements, collections - Accounts receivable management |
Question 1
Blue Shield (BS) __________
A. began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1940; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
B. began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1941; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
C. began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1938; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
D. began as a resolution passed by the house of Delegates at an American Medical Association meetings in 1939; incorporates a concept of voluntary health insurance that encourages physicians to corporate with prepaid health plans.
Question 2
EDD
A. (California) Employment Development Department
B. Electronic funds transfer
C. Employer group health plan
D. Electronic data interchange
Question 3
FECA stands for Federal Employment Compensation Act.
A. FALSE
B. TRUE
Question 4
FEP stands for Federal Employee Program.
A. FALSE
B. TRUE
Question 5
837
A. Claims validation table (as in ANSI ASC X10 837)
B. Claims validation table (as in ANSI ASC X11 837)
C. Claims validation table (as in ANSI ASC X13 837)
D. Claims validation table (as in ANSI ASC X12 837)
Solutions:
| Question 1 Answer: C | Question 2 Answer: A | Question 3 Answer: B | Question 4 Answer: B | Question 5 Answer: D |
Quincy
Theobald
Yehudi
Blanche
Eartha
Harriet
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