CPB Medical Billing study plan

Map the full revenue cycle from patient registration through final payment posting, and label where each of the four exam domains touches it

Define and correctly use core terminology: claim, clean claim, EOB, ERA, remittance advice, deductible, coinsurance, copay, allowed amount, write-off

Trace how a CPT code, an ICD-10-CM code, and a HCPCS Level II code each enter a claim and what each one justifies

Build a one-page glossary of 40 billing terms with a worked example for each of the 10 highest-risk terms

Differentiate CPT category I, II, and III codes and identify when an unlisted-procedure code is appropriate

Apply ICD-10-CM coding conventions including laterality, seventh characters, and excludes notes to select a principal diagnosis

Distinguish modifier use cases such as 25, 59, and the X{EPSU} family, and predict when a payer will deny for missing or misused modifiers

Calculate patient responsibility from allowed amount, deductible remaining, coinsurance percentage, and copay for five worked scenarios

Compare Medicare, Medicaid, commercial, and workers' compensation payers on eligibility rules, timely filing, and appeal rights

Sequence payers correctly for a patient with primary and secondary coverage and explain the birthday rule and Medicare Secondary Payer rules

Read a sample EOB and ERA line by line and post payments, adjustments, and denials to the correct ledger fields

Identify the fields most often responsible for front-end claim rejections and state the fix for each

Verify eligibility and benefits for a set of sample patients and document coverage limits, referral needs, and prior authorization requirements

Explain prior authorization, referral, and notification workflows and predict the denial that results when each is skipped

Distinguish credentialing, contracting, and enrollment, and describe how a lapsed credential affects claim payment

Match common payer-specific rules, such as modifier and medical-necessity policies, to the denials they cause

Categorize denials by root cause: eligibility, authorization, coding, medical necessity, timely filing, and coordination of benefits

Calculate filing deadlines and appeal windows from sample payer policies and flag claims at risk of aging out

Draft a first-level appeal letter that cites the specific policy, code, and clinical documentation supporting reversal

Build a denial-tracking log with fields that support trending by payer and by root cause

Apply the correct sequence for patient collections, from statement through final notice, while staying within fair-billing limits

Explain how the No Surprises Act, price transparency, and good-faith estimate requirements affect patient billing conversations

Distinguish fraud, waste, and abuse and identify the intent element that separates an error from fraud

Describe the roles of the OIG, CMS, and payer special investigation units and what triggers each to review a provider

Apply HIPAA Privacy and Security Rule requirements to billing tasks, including minimum necessary, business associates, and breach response

Identify Stark and Anti-Kickback Statute risk in common arrangements such as discounts, waivers, and referral incentives

Explain the functions of a compliance program: policies, training, auditing, monitoring, and non-retaliation

Recognize red flags in claims data, such as upcoding patterns and unbundling, and state the corrective action

Complete two full-length timed practice exams under test conditions and score each domain separately

Re-study only the two weakest domains using targeted drills on missed question types

Rehearse the math and rule recall most likely to be tested: patient responsibility, timely filing, appeal levels, and modifier logic

Build a one-page exam-day reference sheet of rules you must recall without prompts