CHAMPUS

·        Determine the personal deductible for military retirees on the TRICARE Standard

·        Define the Defense Enrollment Eligibility Reporting System (DEERS)

HIPAA

·        Explain how HIPAA applies to Electronic Claims, Information Security, and Patient Privacy

Medicaid

·        Determine the time frame for submitting a traditional Medicaid claim

·        Determine the maximum time frame for filing an appeal for a Medicaid claim

·        Define and apply the theory of reciprocity

·        Identify which group is excluded from Medicaid cost sharing

Medical Billing Basic Knowledge

·        Determine which diagnoses, procedures, modifiers, and multipliers should be placed on a claim form

·        Identify and define symbols used in the CPT book

·        Define HCPCS Codes

·        Define Super bill

Medical Billing Process

·        Define upcoding

Medicare

·        Identify which agency issues the UPIN codes

·        Define Medigap, and prevailing charge

·        Determine benefits for Part A and Part B of Medicare

·        Identify the information on a Medicare health card

·        Determine the qualifications for Medicare disability coverage

·        Define the basis of fraud for Medicare purposes

·        Determine a primary and secondary payers for Medicare claiims

Describe the types of claims handled by fiscal intermediaries

TRICARE

·        Determine eligibility

·        Identify the plans and the Fiscal Intermediary

Electronic Claims

·        Identify the advantages of using electronic claims

·        Define clearinghouses

Managed Care

Define Pre-authorization, Capitation, professional courtesy write-off, managed care

Medical Billing

·        Identify the three volumes of the ICD-9-CM

·        Define V codes

·        Determine the number of chapters for classification of diseases and injuries

·        Identify the six sections of the CPT Coding Book

·        Identify the key components in the Evaluation and Management code section

·        Identify and define symbols used in the CPT book

·        Locate where the short code descriptions for the current year in the CPT book

·        Determine the time required for medical record retention

·        Identify the form indicators on the HCFA Forms

·        Define the following terms:  Diagnostic Related Groups (DRG) rate, COBRA, claim window, indemnity benefit, fees schedule, and balanced billing

·        Determine which diagnoses, procedures, modifiers, and multipliers should be placed on a claim form

·        Determine which box on the HCFA form the MEDIGAP information appears

·        Determine the place of service code

Medical Billing Documents

·        Identify where the date of birth is placed on the CMS Form 1500

·        Determine the proper way to bill the repair of multiple lacerations

Medical Terminology

·        Define the following terms:  malac(o), syndesm, abduction, ule, dolicho, chronic, trophy, radius, rachi, ectasia, obstetrician, specialist and colpospasm.

Specialty Billing

·        Define ERISA Benefit Requirements and ERISA Eligibility

Workman's Comp

·        Define Workman’s Compensation benefits

·        Define the FECA Program