CPB study kit
Cheatsheet, term cards, never-miss list, and a seven-day plan. Original study material.
The rule
Identify the payer, complete the claim from the record, and route the denial by its reason.
No note, no claim. Invalid member ID goes back to eligibility, not to a new diagnosis.
Never miss
- Medicare is federal. Medicaid is joint federal-state and state-specific.
- Medicare Advantage claims go to the plan, not to CMS paper central.
- The birthday rule is a COB convention unless a court order says otherwise.
- Professional claims use the CMS-1500 path. Institutional claims use the UB-04 path.
- Place of service must match where the service was furnished.
- Timely filing lives on the notice or contract. Do not invent a universal day count.
Traps
- Using a sibling's member ID so something pays.
- Balance-billing a Medicare patient for a contractual amount.
- Treating every denial as a coding problem.
- Cloning last year's note to support today's claim.
Shortcuts
- Read reason and remark codes first.
- Eligibility rejects are access data.
- Underpayments are contract math plus the record.
Memory hooks
- REASON-OWNER. The denial reason names the next owner Authorization, eligibility, medical necessity, and timely filing are different desks.
A recognized billing credential. Agencies do not require it.
- Day 1Payer types and coordinationRead the Payer types and coordination terms, then the never-miss lines that touch this domain.
- Day 2Billing regulations and ABNRead the Billing regulations and ABN terms, then the never-miss lines that touch this domain.
- Day 3Claims, forms, and submissionRead the Claims, forms, and submission terms, then the never-miss lines that touch this domain.
- Day 4Denials, posting, and follow-upRead the Denials, posting, and follow-up terms, then the never-miss lines that touch this domain.
- Day 5Documentation supportRead the Documentation support terms, then the never-miss lines that touch this domain.
- Day 6Mixed recallRun the term cards, then a short drill. Restate the one-line rule out loud.
- Day 7Full drillSit the 15-question exam and review every miss against this kit.