PMRP study plan

Map the full revenue cycle from preregistration through collections, naming the owner and handoff at each stage

Sequence the major federal regulations that govern billing (False Claims Act, Anti-Kickback Statute, Stark, HIPAA, EMTALA) and state one compliance risk each creates

Distinguish Medicare, Medicaid, commercial, and self-pay payer rules for eligibility, coverage, and cost sharing

Build a personal glossary of at least 25 revenue cycle terms with a one-sentence definition for each

Apply registration data-quality standards by identifying the fields that most often cause downstream denials

Practice verifying eligibility and benefits for three payer types and document what each verification must capture

Explain patient financial counseling options, including charity care, payment plans, and estimates, and when each applies

Identify notice-of-admission and consent requirements that affect billing compliance

Differentiate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS and state what each code set is used for

Trace how documentation supports code selection and where gaps create denials or compliance exposure

Explain charge capture workflows, charge master maintenance, and the risks of missed or duplicated charges

Describe clinical documentation integrity queries and the difference between a query and leading the provider

Sequence claim submission, clearinghouse edits, and payer adjudication through remittance

Interpret common claim edits and rejection reasons and state the corrective action for each

Explain coordination of benefits and how primary versus secondary payer rules change the claim

Distinguish payer adjudication outcomes: paid, denied, rejected, and pending

Categorize denials by root cause (registration, coding, authorization, medical necessity, timely filing) and rank by recoverability

Draft appeal letters for at least two denial types using payer-specific requirements and supporting documentation

Apply timely filing and appeal deadline rules and describe how to track them

Explain the difference between an appeal, a reconsideration, and a corrected claim

Calculate and interpret A/R aging buckets and days in A/R for a sample account portfolio

Apply collection policy rules, including when accounts move to bad debt or external collection

Post payments, adjustments, and denials accurately and reconcile a remittance against expected reimbursement

Identify underpayment and variance patterns and describe the contract modeling check

Define core revenue cycle KPIs (clean claim rate, denial rate, days in A/R, net collection rate) and how each is calculated

Interpret a KPI dashboard and identify which metric to act on first and why

Explain data security obligations for protected health information under HIPAA and the minimum necessary standard

Describe interoperability standards and how health information exchange affects eligibility and claims data

Revisit the highest-weight domains and close gaps identified in prior practice results

Complete timed practice sets and review every missed item to its root concept

Summarize the top 20 facts most likely to be tested across compliance, coding, and denials

Build a final-week review sheet of formulas, deadlines, and regulatory rules