NCICS study plan

Map the full medical billing and coding revenue cycle from patient registration through claim submission, payer adjudication, remittance posting, and patient collections, writing a one-page flow diagram from memory

Define and distinguish key terms including CPT, ICD-10-CM, ICD-10-PCS, HCPCS Level II, EOB, ERA, EFT, deductible, copay, coinsurance, and allowed amount, producing a personal glossary of at least 40 entries

Identify the major payer categories (Medicare, Medicaid, commercial, TRICARE, workers' compensation) and list the eligibility and coverage differences that affect claim routing

Set up a study tracking system that logs hours, topics covered, and practice-question accuracy per session so weak areas can be measured weekly

Explain the structure of CPT codes including category, subcategory, and code-level organization, and locate codes within each of the six CPT sections without reference to a specific publisher's layout

Apply ICD-10-CM conventions including the tabular list, alphabetic index, placeholders, excludes notes, and seventh-character requirements to assign diagnosis codes for 20 practice scenarios

Distinguish HCPCS Level II code ranges and identify which supply, drug, and service categories each letter series represents

Demonstrate correct use of modifiers by selecting the appropriate modifier for 15 operative and billing scenarios, including modifiers for bilateral procedures, multiple procedures, and distinct services

Describe the difference between prospective and retrospective payment and explain how MS-DRG, APC, and RBRVS-based fee schedules determine reimbursement in inpatient, outpatient, and physician settings

Calculate expected reimbursement for at least 10 scenarios involving allowed amounts, contractual adjustments, coinsurance, and deductible application

Explain the purpose and content of the CMS-1500 claim form and the UB-04 claim form, field by field, and identify which fields cause the most common claim rejections

Practice applying National Correct Coding Initiative edits and understand when modifier 59 or an equivalent is and is not appropriate

Review weeks 1 through 3 material and close the three weakest topic areas identified by practice-question accuracy logs

Explain the medical necessity concept and how documentation, diagnosis linkage, and advance beneficiary notice requirements interact in billing decisions

Describe the appeals and denial management process including timely filing limits, redetermination, reconsideration, and the role of each party in a payer appeal

Complete a timed 60-question mixed practice set covering coding fundamentals, reimbursement, and claim forms

Explain compliance requirements affecting billing and coding including the False Claims Act, Anti-Kickback Statute, Stark Law, HIPAA privacy and security rules, and the OIG work plan's relevance to coding audits

Describe the components of an internal compliance program and the purpose of coding audits, including how audit sampling and error-rate calculation work

Identify fraud and abuse red flags such as upcoding, unbundling, and duplicate billing, and explain the correct response when one is identified

Explain the roles and credentialing pathways of coders, billers, and auditors, and the certification maintenance expectations for each

Trace the lifecycle of a claim from charge capture through clearinghouse edits, payer edits, and final adjudication, naming the specific reason a claim can stop at each stage

Explain the difference between claim rejection and denial and describe the corrective action for each

Describe how electronic remittance advice and electronic funds transfer are reconciled against posted charges, including how to handle partial payments and zero-pay remittances

Practice interpreting at least 10 sample remittance scenarios and determine the correct next action for each

Review weeks 5 and 6 material and close remaining weak areas identified by practice accuracy logs

Complete a timed 100-question mixed practice set under exam-like conditions with no notes

Analyze every missed question from the 100-question set by error type: knowledge gap, misread question, coding lookup error, or time pressure

Rehearse time management by completing 25 questions in 30 minutes with a target accuracy of at least 80 percent

Consolidate the highest-yield facts across all domains into a single one-page final review sheet covering code structures, reimbursement formulas, claim form fields, compliance rules, and appeal timelines

Complete two timed full-length practice exams and score at or above your target passing threshold on the second attempt

Recite from memory the reimbursement calculation steps, the claim rejection versus denial distinction, and the appeal process sequence without notes

Finalize a test-day plan covering timing per question, when to flag and return, and how to handle unfamiliar code lookups