CPRH® About the exam

After purchasing, you must apply and be approved to take the CPRH Exam.

➯ Applicants must demonstrate least 3 years professional experience in one or more relevant, qualifying roles.
➯ The exam consists of a series of multiple choice questions, and written responses.
➯ The exam is taken in one sitting and testing time will last for approximately three (3) hours

➯ Enjoy access to CPRH reference and educational materials with your subscription.

• U.S. Market Access Processes
  • Design of the Medicare Program, Department of Health and Human Services, and FDA
  • Fundamentals of Healthcare Coding
  • Coding Governing Organizations
  • Medicare Reimbursement Mechanisms for: Physicians, Hospitals, Pharmaceuticals, Medical Devices, Diagnostics, etc.
  • 2 Short Essays: Market Access Strategy: planning to make sure a new product is covered by insurance.

• Healthcare Reimbursement
  • Claims processing: CMS-1500 and UB-04 Forms
  • Medicare Program Provider Types
  • Claim Rejection, Denial and Appeal
  • CPT, HCPCS, ICD-10-CM/PCS, LOINC, NDC and UDI Coding Function
  • Health Policy Fundamentals: Medicare and Private Payer Coverage

• U.S. Laws and Regulations
  • HIPAA, Medicare Modernization Act, Affordable Care Act
  • Healthcare Fraud Statues
  • Anti-Kickback and Safeharbors for Value Based Healthcare
  • MACRA and Medicare QPP Program (MIPS)
  • Laws governing reimbursement rates and pricing

• Health Economics
  • Value Based Healthcare
  • Healthcare Data Sources
  • Payment Reform (ACOs, bundling, risk sharing)
  • Health Technology Assessments, Levels of Evidence and its Impact on Healthcare Policy
  • Cost-effectiveness analysis
  • Clinical Trial Design for Patient Access