PMRP study guide
PMRP · Work through your exam, one topic at a time.
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 study guide has 9 sections and about 2,395 words.
01Revenue Cycle Fundamentals and Regulatory Compliance
This domain tests the end-to-end revenue cycle and the laws that constrain it. Expect questions on Medicare Secondary Payer (MSP), the False Claims Act (FCA), Anti-Kickback Statute (AKS), Stark Law, HIPAA, EMTALA, 501(r), the No Surprises Act, and Medicare Advance Beneficiary Notices (ABNs).
349 words, about 2 min02Patient Access, Registration, and Financial Counseling
Patient access sets the financial and clinical stage. The exam tests eligibility verification (270/271), benefits, prior authorization, coordination of benefits, MSPQ, patient estimates, point-of-service collections, and charity screening.
285 words, about 1 min03Coding, Charge Capture, and Clinical Documentation Integrity
This domain tests ICD-10-CM, CPT, HCPCS, E/M level selection, modifiers, NCCI edits, charge capture, and CDI. Office E/M visits use medical decision making or total time; the 2021 and 2023 guideline changes altered history and exam requirements.
281 words, about 1 min04Claims Management and Payer Adjudication
This domain covers claim creation (837P/837I), clearinghouse edits, payer adjudication, remittance (835), CARC/RARC, and coordination of benefits. A clean claim contains required and valid data; front-end edits catch demographic, eligibility, and coding errors.
241 words, about 1 min05Denial Management and Appeals
This domain tests denial classification, root-cause analysis, appeal levels and deadlines, and prevention. Denial types include eligibility, authorization, coding/bundling, medical necessity, timely filing, duplicate, and COB.
250 words, about 1 min06Accounts Receivable and Collections
This domain covers AR aging, follow-up, self-pay collections, charity care, and collection laws. Days in AR = (total AR / total charges) × days in period; use billed charges consistently.
246 words, about 1 min07Payment Posting, Reconciliation, and Revenue Integrity
This domain tests cash posting, ERA/835 posting, contractual adjustments, reconciliation, refunds, and revenue integrity. Post payments, patient responsibility, and contractual adjustments at the line level using CARC and RARC.
231 words, about 1 min08Revenue Cycle Analytics, Metrics, and Reporting
This domain tests KPI definitions, dashboard design, benchmarking, and data interpretation. Clean claim rate: claims accepted first pass divided by total claims.
233 words, about 1 min09Technology, Data Security, and Interoperability
This domain tests RCM systems, HIPAA privacy and security, breach notification, and health data exchange. HIPAA Security Rule safeguards are administrative, physical, and technical; a risk analysis is required.
279 words, about 1 min