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Certified Outpatient Coder (COC) 

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Payment Methodologies (20)

• ​Services covered by Medicare Parts A, B, C, and D

  • PART A ​"Inpatient/ Hospital"

  • Part B "Outpatient/ Medical" 

  • Part C 

  • Part D "Drug Coverage" 

• Medicare as a secondary payer

• Requirements for completion of UB04 claim form

• Requirements for completion of CMS 1500 claim form

• OPPS Payment Methodology

• APCs

• Revenue codes

• Status Indicators

• Payment Indicators

• Condition codes

• Calculation of proper payments (excerpts from Addendum B and Addendum AA are provided on the exam)

• IPPS  Payment Methodology

• Elements needed to determine MS-DRGs

• Code sets required for inpatient claims

• Reimbursement for teaching hospital setting

• Charge masters

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• Compliance (5) 

  • NCDs/LCDs

  • HIPAA

  • ABNs (only apply to Original Medicare)

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