CHBME study plan

Map the full revenue cycle end to end (scheduling, registration, eligibility, coding, charge capture, claim submission, adjudication, denial management, patient collections) and label each stage with its owner and key handoff

Define and memorize the core financial metrics: gross and net collection rate, days in accounts receivable, first-pass resolution rate, denial rate, contractual adjustment, and clean claim rate, including the formula for each

Trace a single claim through every stage on paper and identify the three points where revenue most often leaks

Build a personal glossary of at least 40 revenue cycle terms with a one-line definition for each

Differentiate payer types (commercial, Medicare, Medicaid, workers' compensation, self-pay) and describe how each affects eligibility checks, timely filing, and reimbursement rules

Explain the roles of HIPAA, the False Claims Act, the Anti-Kickback Statute, and the Stark Law in billing compliance, and give one violation scenario for each

Distinguish fraud from abuse and outline the elements of a compliance program

Practice applying a timely-filing rule to a set of dated claim scenarios and determine which are at risk

Explain the purpose and structure of CPT, HCPCS Level II, ICD-10-CM, and ICD-10-PCS and how each is used on a claim

Describe modifiers and identify when common ones (for example, distinct procedural service, multiple procedures, bilateral) change payment

Walk through the medical necessity link between diagnosis and procedure codes and explain how a mismatch triggers a denial

Complete 20 coding-to-claim linkage exercises and justify each code pairing

Describe the chargemaster: who owns it, how charge descriptions map to codes, and how annual updates are managed

Explain charge capture methods (encounter forms, electronic order entry, interface feeds) and identify common missed-charge causes

Calculate expected reimbursement for sample claims under fee-for-service, case rate, and per-diem contracts

Explain how payer contracts, fee schedules, and allowed amounts drive the expected-versus-actual payment comparison

Trace the claim lifecycle from scrubber edits through clearinghouse to payer adjudication, naming the failure point at each step

Interpret a sample remittance advice: identify paid, denied, and adjusted amounts and explain each adjustment reason code

Explain the appeals process, including levels, deadlines, and documentation required

Categorize denials by root cause (registration, eligibility, coding, authorization, medical necessity, timely filing) and match each to a prevention control

Design a denial management workflow from denial receipt to resolution, including owner, turnaround target, and escalation path

Explain accounts receivable aging, how to prioritize work queues, and how to calculate days in A/R and identify outliers

Describe the patient financial experience: price transparency, good-faith estimates, point-of-service collections, and payment plan design

Compute net collection rate and days in A/R from a sample data set and interpret whether performance is healthy

Explain key performance indicators across the cycle and how each connects to cash flow and organizational goals

Identify the leading causes of claim rejections and denials and rank them by financial impact

Describe how front-end accuracy (registration, eligibility, prior authorization) reduces downstream rework and write the business case for front-end investment

Outline a process improvement cycle for one revenue cycle problem, including baseline measure, intervention, and re-measurement

Review all prior weeks' notes and consolidate weak areas into a prioritized review list

Complete a timed 100-question practice set and analyze every missed item by domain and root cause

Re-teach the five weakest concepts in writing without notes to confirm mastery

Build a final one-page formula and concept sheet for exam-day reference