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.
- Rate Yourself: For each topic, be honest about your current comfort level.
- 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").
- Identify the Gap: In the "Textbook Nuance" column, note anything the MBC textbook emphasizes that differs from your real-world workflow.
- 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) |
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| - Eligibility & Enrollment |
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| - Covered Services |
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| - Participation Levels (PAR/NON-PAR) |
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| - Limiting Charge |
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| - Advance Beneficiary Notice (ABN) |
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| Medicaid & CHIP |
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| - Dual-Eligibles (Medicare/Medicaid) |
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| Commercial Insurance |
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| - HMO, PPO, POS, EPO, HDHP |
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| - Premiums, Deductibles, Copays, Coinsurance |
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| - Out-of-Pocket Maximums |
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| Managed Care |
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| - Referrals & Authorizations |
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| - Capitation vs. Fee-for-Service |
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| Workers' Compensation |
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| TRICARE & VA |
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| 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 |
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| Stark Law (Physician Self-Referral) |
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| Anti-Kickback Statute |
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| Civil Monetary Penalties Law |
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| Fraud vs. Abuse (Definitions) |
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| Corporate Compliance Plans |
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| OIG Work Plan |
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| 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 |
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| - Permitted Uses & Disclosures |
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| - Minimum Necessary Standard |
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| - Notice of Privacy Practices (NPP) |
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| HIPAA Security Rule |
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| - Administrative, Physical, Technical Safeguards |
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| HIPAA Transactions & Code Sets |
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| - Electronic Transactions (837, 835, 270/271, 276/277) |
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| Breach Notification Rule |
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| 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) |
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| - Reading & Interpreting EOBs |
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| - Patient Responsibility (Deductible, Coinsurance, Copay) |
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| - COB (Coordination of Benefits) |
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| - Non-Covered Services |
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| Remittance Advice (RA / ERA) |
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| - Claim Adjustment Group Codes (PR, CO, OA, PI) |
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| - CARC (Claim Adjustment Reason Codes) |
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| - RARC (Remittance Advice Remark Codes) |
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| Payment Posting |
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| - Contractual Adjustments |
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| - Write-Offs |
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| Patient Billing & Collections |
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| - Timely Filing for Patient Responsibility |
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| - Collection Agency Placement |
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| - Bankruptcy & Estate Claims |
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| Refunds |
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| - 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 |
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| - Demographic Data Collection |
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| - Insurance Verification |
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| - Eligibility Checks (270/271) |
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| - Benefit Determination |
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| - Authorization & Referral Management |
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| Financial Responsibility |
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| - Estimate Patient Liability |
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| - Collecting Copays/Coinsurance Upfront |
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| - Financial Assistance / Charity Care |
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| - Payment Plans |
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| CMS-1500 Claim Form |
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| - Box 24 A-J (line-by-line) |
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| - Box 33 (Billing Provider) |
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| - Place of Service Codes |
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| - Type of Service Codes |
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| UB-04 Claim Form |
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| - Revenue Codes |
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| - Condition Codes |
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| - Occurrence Codes |
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| - Value Codes |
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| Claim Submission |
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| - Clean Claim vs. Dirty Claim |
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| - Electronic Submission (837P, 837I) |
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| - Paper Submission (when required) |
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| - Clearinghouses (function & purpose) |
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| Claim Adjudication |
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| - Timely Filing Deadlines |
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| - Payer-Specific Rules |
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| Denials Management |
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| - Rejection vs. Denial |
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| - Common Denial Codes (CO, PR, OA) |
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| - Corrective Action by Denial Type |
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| - Corrected Claims vs. Appeals |
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| Appeals Process |
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| - Level 1: Redetermination |
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| - Level 2: Reconsideration |
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| - Level 3: ALJ Hearing |
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| - Appeals Letter Writing |
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| - 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) |
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| - Medical Necessity (Linking Diagnosis to Procedure) |
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| - Primary vs. Secondary Diagnoses |
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| - POA (Present on Admission) Indicators |
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| CPT (Procedure Codes) |
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| - Category I, II, III |
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| - Unlisted Procedures |
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| HCPCS Level II |
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| - Supplies, DME, Drugs |
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| - Modifiers (A1, EY, GA, GX, etc.) |
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| Modifiers for Billers |
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| - Common Modifiers (24, 25, 26, 51, 52, 59, 76, 77, 78, 79, 91) |
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| - Modifier Billing Impact (payment reduction, bundling) |
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| NCCI Edits (CCI Edits) |
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| - Column 1/Column 2 Edits |
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| - Mutually Exclusive Edits |
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| - Modifier Indicators |
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| MUEs (Medically Unlikely Edits) |
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| LCDs & NCDs |
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| - Local Coverage Determinations |
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| - 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 |
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| - Pre-Certification |
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| - Pre-Authorization |
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| - Pre-Determination |
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| Concurrent Review |
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| - Continued Stay Review |
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| - Discharge Planning |
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| Retrospective Review |
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| - Medical Record Requests |
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| - Audits (RAC, MAC, CERT) |
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| Care Coordination |
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| - Transitions of Care |
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| - Referring Provider Communication |
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| - 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 |
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| - Internet-Only Manuals (IOMs) |
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| - Medicare Claims Processing Manual |
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| - Medicare Benefit Policy Manual |
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| NCD & LCD Lookup |
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| Coding Resources |
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| - CPT Assistant |
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| - AHA Coding Clinic |
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| Payer Contracts & Policies |
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| - Fee Schedules |
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| - Payer-Specific Billing Manuals |
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| OIG Resources |
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| - Self-Disclosure Protocol |
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| - Exclusion List Check |
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| Practice Management Software |
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| - 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 |
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| 2. Billing Regulations |
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| 3. HIPAA & Compliance |
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| 4. Reimbursement & Collections |
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| 5. Billing Processes |
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| 6. Coding Knowledge |
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| 7. Case Management & Coordination |
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| 8. Resource Use |
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Exam Day Prep Checklist
You've got this, SME. Go pass that exam.
