PMRP case studies
PMRP · Put your knowledge to work in context.
The Professional in Medical Revenue Practice (PMRP) is an independent certification designed for people who manage the money side of healthcare: patient access representatives, coders, claims and denial specialists, accounts receivable analysts, revenue integrity staff, and the managers who oversee them. It tests whether a candidate can follow a dollar from pre-registration through final payment and recognize where the process breaks. The PMRP case studies are 5 cases and about 3,795 words.
1Same-Day Surgery Registration With Terminated Medicaid and a Prior Balance
A 47-year-old patient arrives at 6:40 a.m. for a scheduled outpatient laparoscopic cholecystectomy.
761 words, about 4 min2CO-97 Denials for Same-Day E/M With Minor Procedures
A 12-provider hospital-owned multispecialty clinic receives 23 denials coded CO-97 over six weeks, totaling $11,730. Every denied claim pairs a level-3 or level-4 established-patient E/M with a same-day minor procedure such as lesion destruction, joint injection, or cerumen removal.
763 words, about 4 min3Days in A/R Jump While Cash Is Flat
At the end of Q2, a 180-bed community hospital's CFO reports that days in A/R rose from 38.4 to 52.1 over one quarter, while gross charges increased 6% and cash collections were flat. The revenue cycle director's dashboard shows initial denial rate steady at 5.2%, clean claim rate 96.1%, charge lag 2.1 days, and cost to collect 2.9%.
751 words, about 4 min4Lockbox Variance, Failed 835, and an Unclaimed Refund
On Monday morning, the patient financial services manager reconciles Friday's bank deposit of 184,220 against posted payments of 181,045. The variance is 3,175.
736 words, about 4 min5Post-Discharge Sepsis Query Before Claim Drop
A CDI specialist reviews a 78-year-old inpatient with pneumonia, dehydration, and acute kidney injury. The physician's discharge summary lists "sepsis, resolved" and "UTI," but the admission history and physical documents "urosepsis with hypotension responsive to 1 liter of normal saline," lactate 2.8, and no organ dysfunction after fluid resuscitation.
784 words, about 4 min