CMBB cheat sheet

Behavioral learning objective components (ABCD): Audience, Behavior, Condition, Degree - a usable objective names who performs, the observable verb, the conditions of performance, and the criterion for success.

Bloom's revised taxonomy order: Remember, Understand, Apply, Analyze, Evaluate, Create - lower three are foundational, upper three are higher-order; verbs must match the cognitive level claimed.

Criterion-referenced assessment measures performance against a stated standard; norm-referenced assessment ranks learners against each other - certification exams for medical billing are criterion-referenced.

Formative assessment occurs during instruction and informs adjustment; summative assessment occurs after instruction and certifies achievement.

Constructive alignment rule: learning objectives, instructional activities, and assessment tasks must target the same verb and content; misalignment invalidates validity claims.

Kirkpatrick training evaluation levels in order: Reaction, Learning, Behavior, Results - Level 4 measures organizational outcomes such as clean-claim rate or days in A/R.

Cognitive load theory: intrinsic load is task complexity, extraneous load is poor design; reduce extraneous load (split attention, redundancy) before adding practice difficulty.

Adult learning (Knowles) assumptions: self-concept of autonomy, experience as resource, readiness tied to life roles, problem-centered orientation, internal motivation.

GROW model sequence: Goal, Reality, Options, Will - the Will step must end with a specific action and a date, or the session produces no commitment.

Coaching is non-directive and question-led; the coach does not supply the answer. Distinguish from mentoring (advice from experience) and teaching (content delivery).

Powerful questions are open-ended, short, and free of embedded advice; 'What have you tried?' qualifies, 'Have you tried rebasing the claim?' does not.

Feedback model: observation, impact, request (SBI variant: Situation, Behavior, Impact) - describe observable behavior, not inferred intent.

Goal setting: SMART criteria (Specific, Measurable, Achievable, Relevant, Time-bound); a coaching goal belongs to the coachee, not the coach or the manager.

Feedback should be timely and specific; delayed or trait-based feedback ('you are careless') reduces receptivity and does not change behavior.

Confidentiality boundary: coaching content stays between coach and coachee unless a safety, compliance, or legal-reporting duty overrides it - disclose the limit up front.

Coaching measures leading indicators (actions taken, calls made) rather than lagging outcomes only; lagging metrics such as denial rate respond slowly.

Mentoring transfers experience-based guidance; the mentor may advise and share judgment, which distinguishes it from non-directive coaching.

Mentoring forms: traditional one-to-one, peer, reverse (junior mentors senior on new technology), and group - reverse mentoring is common for EHR and coding-software adoption.

A mentoring agreement should define cadence, duration, confidentiality, and success criteria; open-ended arrangements decay without a review point.

Career functions of mentoring (Kram): sponsorship, exposure, coaching, protection, challenging assignments; psychosocial functions: role modeling, acceptance, counseling, friendship.

Mentoring is distinct from precepting: a preceptor supervises real work and signs off on competence; a mentor does not evaluate performance.

Boundary rule: a mentor who also serves as the mentee's direct supervisor must separate developmental conversations from performance evaluation records.

Mentoring program metrics: retention of mentees, time-to-competence, internal promotion rate, and mentee-reported usefulness - not mentor satisfaction alone.

Succession planning uses mentoring to build a bench; the test is whether a named successor exists for each key revenue-cycle role.

Revenue cycle sequence: preregistration, registration, charge capture, coding, claim submission, payer adjudication, remittance posting, denial management, patient collections.

Key metrics: days in A/R = total A/R ÷ average daily charges; clean-claim rate = claims accepted first pass ÷ total claims submitted.

Denial rate = denied claims ÷ total claims; a denial is a payer rejection requiring appeal or correction, distinct from a rejection (front-end edit failure).

Professional responsibility: bill only services documented and medically necessary; upcoding and unbundling are false claims exposure under the False Claims Act.

HIPAA minimum necessary standard limits use and disclosure of PHI to the least needed for the purpose; the Privacy Rule governs use, the Security Rule governs ePHI safeguards.

Compliance program elements (OIG guidance): written policies, compliance officer, training, communication lines, auditing and monitoring, enforcement, corrective action.

Credentialing vs. enrollment: credentialing verifies clinician qualifications with the payer; enrollment is the contract and network record that permits billing.

Scope of practice: a coder may not assign a diagnosis without physician documentation; query the provider rather than infer.

ICD-10-CM codes are 3–7 characters; the 7th character is a required extension for certain injury, obstetric, and neoplasm chapters and must never be omitted when the code requires it.

CPT code structure: Category I is five digits; modifiers are two characters appended to indicate altered service (e.g., -25 significant, separately identifiable E/M on the same day).

Place of service codes drive payment: POS 11 (office) vs. POS 22 (outpatient hospital) changes facility vs. non-facility rates.

EHR interoperability standards: HL7 v2 for messaging, FHIR for modern APIs, X12 837P/837I for claims, X12 835 for remittance advice, X12 270/271 for eligibility.

E/M coding since 2021 for office visits: level is chosen by medical decision making or total time on the date of the encounter - history and exam are no longer the level driver.

Automation rule: any claim edit or code assignment rule must be traceable to a published source (payer policy, code descriptor, NCCI edit) to survive audit.

NCCI edits: Column 1/Column 2 pairs are not separately payable; modifier -59 or an X-modifier requires documented distinct service.

Innovation evaluation: pilot with a control group, measure baseline and post-implementation metrics, and define rollback criteria before go-live.