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.

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# 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").

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## 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)** | | | | |

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## 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)** | | | | |

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## 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** | | | | |

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## 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) | | | | |

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## 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 | | | | |

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## 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 | | | | |

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## 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 | | | | |

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## 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) | | | | |

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## 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 |
| :---: | :--- | :--- | :---: |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |

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## 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 | | | |

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## 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**.

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**You've got this, SME.** Go pass that exam.