diff --git a/work/Knowledge.Inventory.Worksheet.md b/work/Knowledge.Inventory.Worksheet.md new file mode 100644 index 0000000..e58a0b6 --- /dev/null +++ b/work/Knowledge.Inventory.Worksheet.md @@ -0,0 +1,268 @@ +Here is a comprehensive **Knowledge Inventory Worksheet** in markdown syntax. You can copy and paste this into any markdown editor (like Obsidian, Notion, Typora, or even a code editor) or convert it to PDF for printing. + +--- + +# CPB Exam: Knowledge Inventory Worksheet + +**Name:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ +**Date Started:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ +**Target Exam Date:** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ + +## Instructions for the SME + +This worksheet is designed for **subject matter experts** who are validating existing knowledge rather than learning from scratch. + +1. **Rate Yourself:** For each topic, be honest about your current comfort level. +2. **Document Proof:** In the "SME Proof" column, jot down *how* you know this (e.g., "I do this daily," "I trained a new hire on this," "I handled an audit on this"). +3. **Identify the Gap:** In the "Textbook Nuance" column, note anything the MBC textbook emphasizes that differs from your real-world workflow. +4. **Action Plan:** Decide what you need to do (e.g., "Review chapter 5," "Make flashcards," "Already solid—skip"). + +--- + +## Domain 1: Types of Insurance (10% of Exam) + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **Medicare (A, B, C, D)** | | | | | +| - Eligibility & Enrollment | | | | | +| - Covered Services | | | | | +| - Participation Levels (PAR/NON-PAR) | | | | | +| - Limiting Charge | | | | | +| - Advance Beneficiary Notice (ABN) | | | | | +| **Medicaid & CHIP** | | | | | +| - Dual-Eligibles (Medicare/Medicaid) | | | | | +| **Commercial Insurance** | | | | | +| - HMO, PPO, POS, EPO, HDHP | | | | | +| - Premiums, Deductibles, Copays, Coinsurance | | | | | +| - Out-of-Pocket Maximums | | | | | +| **Managed Care** | | | | | +| - Referrals & Authorizations | | | | | +| - Capitation vs. Fee-for-Service | | | | | +| **Workers' Compensation** | | | | | +| **TRICARE & VA** | | | | | +| **Auto/Personal Injury Protection (PIP)** | | | | | + +--- + +## Domain 2: Billing Regulations (15% of Exam) + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **False Claims Act** | | | | | +| **Stark Law (Physician Self-Referral)** | | | | | +| **Anti-Kickback Statute** | | | | | +| **Civil Monetary Penalties Law** | | | | | +| **Fraud vs. Abuse (Definitions)** | | | | | +| **Corporate Compliance Plans** | | | | | +| **OIG Work Plan** | | | | | +| **CMC (Compliance & Medicare Manuals)** | | | | | + +--- + +## Domain 3: HIPAA & Compliance (10% of Exam) + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **HIPAA Privacy Rule** | | | | | +| - Permitted Uses & Disclosures | | | | | +| - Minimum Necessary Standard | | | | | +| - Notice of Privacy Practices (NPP) | | | | | +| **HIPAA Security Rule** | | | | | +| - Administrative, Physical, Technical Safeguards | | | | | +| **HIPAA Transactions & Code Sets** | | | | | +| - Electronic Transactions (837, 835, 270/271, 276/277) | | | | | +| **Breach Notification Rule** | | | | | +| **HIPAA Enforcement & Penalties** | | | | | + +--- + +## Domain 4: Reimbursement & Collections (15% of Exam) + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **Explanation of Benefits (EOB)** | | | | | +| - Reading & Interpreting EOBs | | | | | +| - Patient Responsibility (Deductible, Coinsurance, Copay) | | | | | +| - COB (Coordination of Benefits) | | | | | +| - Non-Covered Services | | | | | +| **Remittance Advice (RA / ERA)** | | | | | +| - Claim Adjustment Group Codes (PR, CO, OA, PI) | | | | | +| - CARC (Claim Adjustment Reason Codes) | | | | | +| - RARC (Remittance Advice Remark Codes) | | | | | +| **Payment Posting** | | | | | +| - Contractual Adjustments | | | | | +| - Write-Offs | | | | | +| **Patient Billing & Collections** | | | | | +| - Timely Filing for Patient Responsibility | | | | | +| - Collection Agency Placement | | | | | +| - Bankruptcy & Estate Claims | | | | | +| **Refunds** | | | | | +| - Overpayment Refunds (Patient & Payer) | | | | | + +--- + +## Domain 5: Billing Processes (20% of Exam) — *The Heart of the Exam* + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **Preregistration / Registration** | | | | | +| - Demographic Data Collection | | | | | +| - Insurance Verification | | | | | +| - Eligibility Checks (270/271) | | | | | +| - Benefit Determination | | | | | +| - Authorization & Referral Management | | | | | +| **Financial Responsibility** | | | | | +| - Estimate Patient Liability | | | | | +| - Collecting Copays/Coinsurance Upfront | | | | | +| - Financial Assistance / Charity Care | | | | | +| - Payment Plans | | | | | +| **CMS-1500 Claim Form** | | | | | +| - **Box 24 A-J (line-by-line)** | | | | | +| - **Box 33 (Billing Provider)** | | | | | +| - Place of Service Codes | | | | | +| - Type of Service Codes | | | | | +| **UB-04 Claim Form** | | | | | +| - Revenue Codes | | | | | +| - Condition Codes | | | | | +| - Occurrence Codes | | | | | +| - Value Codes | | | | | +| **Claim Submission** | | | | | +| - Clean Claim vs. Dirty Claim | | | | | +| - Electronic Submission (837P, 837I) | | | | | +| - Paper Submission (when required) | | | | | +| - Clearinghouses (function & purpose) | | | | | +| **Claim Adjudication** | | | | | +| - Timely Filing Deadlines | | | | | +| - Payer-Specific Rules | | | | | +| **Denials Management** | | | | | +| - **Rejection vs. Denial** | | | | | +| - Common Denial Codes (CO, PR, OA) | | | | | +| - Corrective Action by Denial Type | | | | | +| - Corrected Claims vs. Appeals | | | | | +| **Appeals Process** | | | | | +| - Level 1: Redetermination | | | | | +| - Level 2: Reconsideration | | | | | +| - Level 3: ALJ Hearing | | | | | +| - Appeals Letter Writing | | | | | +| - Timely Filing for Appeals | | | | | + +--- + +## Domain 6: Coding Knowledge (10% of Exam) + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **ICD-10-CM (Diagnosis Codes)** | | | | | +| - Medical Necessity (Linking Diagnosis to Procedure) | | | | | +| - Primary vs. Secondary Diagnoses | | | | | +| - POA (Present on Admission) Indicators | | | | | +| **CPT (Procedure Codes)** | | | | | +| - Category I, II, III | | | | | +| - Unlisted Procedures | | | | | +| **HCPCS Level II** | | | | | +| - Supplies, DME, Drugs | | | | | +| - Modifiers (A1, EY, GA, GX, etc.) | | | | | +| **Modifiers for Billers** | | | | | +| - Common Modifiers (24, 25, 26, 51, 52, 59, 76, 77, 78, 79, 91) | | | | | +| - Modifier Billing Impact (payment reduction, bundling) | | | | | +| **NCCI Edits (CCI Edits)** | | | | | +| - Column 1/Column 2 Edits | | | | | +| - Mutually Exclusive Edits | | | | | +| - Modifier Indicators | | | | | +| **MUEs (Medically Unlikely Edits)** | | | | | +| **LCDs & NCDs** | | | | | +| - Local Coverage Determinations | | | | | +| - National Coverage Determinations | | | | | + +--- + +## Domain 7: Case Management & Coordination (10% of Exam) + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **Prospective Review** | | | | | +| - Pre-Certification | | | | | +| - Pre-Authorization | | | | | +| - Pre-Determination | | | | | +| **Concurrent Review** | | | | | +| - Continued Stay Review | | | | | +| - Discharge Planning | | | | | +| **Retrospective Review** | | | | | +| - Medical Record Requests | | | | | +| - Audits (RAC, MAC, CERT) | | | | | +| **Care Coordination** | | | | | +| - Transitions of Care | | | | | +| - Referring Provider Communication | | | | | +| - Post-Discharge Follow-Up | | | | | + +--- + +## Domain 8: Resource Use (10% of Exam) + +| Topic | SME Confidence (1-5) | SME Proof (How I know this) | Textbook Nuance / Gap (What the exam cares about) | Action Plan | +| :--- | :---: | :--- | :--- | :--- | +| **CMS Manuals** | | | | | +| - Internet-Only Manuals (IOMs) | | | | | +| - Medicare Claims Processing Manual | | | | | +| - Medicare Benefit Policy Manual | | | | | +| **NCD & LCD Lookup** | | | | | +| **Coding Resources** | | | | | +| - CPT Assistant | | | | | +| - AHA Coding Clinic | | | | | +| **Payer Contracts & Policies** | | | | | +| - Fee Schedules | | | | | +| - Payer-Specific Billing Manuals | | | | | +| **OIG Resources** | | | | | +| - Self-Disclosure Protocol | | | | | +| - Exclusion List Check | | | | | +| **Practice Management Software** | | | | | +| - System Features (billing, scheduling, reporting) | | | | | + +--- + +## Master Gap List + +*Use this section to consolidate all "Action Plan" items into a single prioritized to-do list.* + +| Priority (H/M/L) | Topic | Specific Action (e.g., "Read MBC Chapter 4, pages 45-60") | Status | +| :---: | :--- | :--- | :---: | +| | | | | +| | | | | +| | | | | +| | | | | +| | | | | +| | | | | +| | | | | +| | | | | + +--- + +## Confidence Tracker + +*After completing your action items, re-rate your confidence.* + +| Domain | Initial Confidence (Avg) | Final Confidence (Avg) | Notes | +| :--- | :---: | :---: | :--- | +| 1. Types of Insurance | | | | +| 2. Billing Regulations | | | | +| 3. HIPAA & Compliance | | | | +| 4. Reimbursement & Collections | | | | +| 5. Billing Processes | | | | +| 6. Coding Knowledge | | | | +| 7. Case Management & Coordination | | | | +| 8. Resource Use | | | | + +--- + +## Exam Day Prep Checklist + +- [ ] I have reviewed my "Master Gap List" one last time. +- [ ] I have taken at least one full-length practice exam under timed conditions. +- [ ] I know which domains are my strongest (for quick points). +- [ ] I know which topics need a "process of elimination" approach if I get stuck. +- [ ] I have my exam confirmation, ID, and any allowed materials ready. +- [ ] I am confident that I have **validated my expertise** and **shored up the gaps**. + +--- + +**You've got this, SME.** Go pass that exam. \ No newline at end of file