NHA CBCS study plan

Map the full claims lifecycle from patient registration through final payment, labeling each handoff and the staff role responsible.

Identify and define key claim-related terms: clean claim, scrubber, clearinghouse, payer, EOB, remittance advice, and denial.

Explain the difference between upcoding, downcoding, and unbundling, and give one compliant example of each.

List the required data elements of a CMS-1500 claim form and match each to its source in the patient record.

Differentiate eligibility verification, prior authorization, and referral requirements, and state when each is needed.

Apply medical necessity basics by matching diagnosis codes to procedure codes using official coding guidelines.

Sequence primary, secondary, and tertiary diagnoses on a sample claim and justify the order.

Describe how coordination of benefits (COB) affects claim submission when a patient has two payers.

Categorize denial reasons into registration, coding, authorization, and timely filing, and propose a prevention step for each.

Outline the appeals process, including levels, time limits, and required documentation for a first-level appeal.

Explain how to read an EOB and remittance advice to identify denial codes and patient responsibility.

Draft a professional appeal letter for a denied claim using a provided scenario.

Describe claim status follow-up methods, including payer portals, clearinghouse reports, and phone etiquette.

Explain the impact of timely filing deadlines and how to calculate days remaining on a claim.

Identify common claim edits (NCCI, MUE, LCD) and how to resolve them before submission.

Summarize HIPAA privacy and security rules as they apply to claims transmission and storage.

Explain the difference between patient payments, insurance payments, and adjustments, and where each appears on a ledger.

Calculate patient responsibility using deductible, coinsurance, and copay in three practice scenarios.

Describe how to post an insurance payment and write off a contractual adjustment correctly.

Identify common invoicing errors that lead to patient complaints and how to prevent them.

Outline the patient billing cycle from statement generation to collections, including statement timing rules.

Explain the requirements for a compliant financial policy, including payment plans and charity care.

Describe how to handle patient inquiries about bills while maintaining professionalism and accuracy.

Differentiate between a patient statement, an invoice, and a receipt, and state when each is used.

Integrate claims and payment processes by tracing a claim from submission through payment posting and patient billing.

Identify how denials and underpayments affect revenue cycle metrics such as days in A/R and clean claim rate.

Apply HIPAA and fraud, waste, and abuse (FWA) principles to billing and collection scenarios.

Practice exam-style questions covering both domains and review missed concepts.

Review all glossary terms, denial categories, and payment posting rules using spaced repetition.

Complete a timed 50-question practice test covering both domains and score at least 80%.

Analyze incorrect practice test answers and create a one-page summary of weak areas.

Finalize a personal exam-day checklist covering timing, materials, and stress management.