Foundations
Terminology, anatomy by body system, HIPAA & compliance, how a claim flows from encounter → code → payer → payment/denial.
Exit check: you can read a short clinic note and name the body system, the reason for visit, and who gets billed.
CPC first • Then CPMA auditing + CRC risk adjustment
A complete starter path for a new learner: foundations and CPC-level coding first, then the specialist work employers still need humans for — auditing, risk adjustment, CDI, and denials. No experience assumed.
Honest expectations: The AAPC CPC exam is 100 multiple-choice questions in 4 hours; 70% is passing. Certification gets you eligible — the first chart experience is still the hardest hire to land. This app builds both: exam skill and audit/risk judgment from the start.
Progress lives in this tab until you export it below. Export after every study session — that file is your save.
Work top to bottom. Phases 5–6 are planned in full so you can see where you're headed, even while you're still on Phase 1.
Terminology, anatomy by body system, HIPAA & compliance, how a claim flows from encounter → code → payer → payment/denial.
Exit check: you can read a short clinic note and name the body system, the reason for visit, and who gets billed.
ICD-10-CM guidelines, CPT by section, HCPCS Level II, modifiers, E/M, surgery / radiology / medicine basics.
Exit check: 80%+ on timed section drills with your code books (or encoder) — speed matters as much as accuracy.
Timed mocks, domain scores, error log, test-day strategy. Fix your two weakest domains, then re-test.
Exit check: two full mocks at 75%+ before you schedule the real exam.
Audit sampling, error classification, documentation-vs-code mismatch, OIG risk, provider feedback, defending a code.
This is the anti-automation skill: someone accountable has to stand behind the code.
CMS-HCC model, MEAT criteria, chronic-condition capture, RAF impact, suspect conditions, RADV audit risk.
Every HCC must be supported in that year's documentation — a problem list alone is not enough.
CDI queries, denials & appeals, Epic / Oracle Health workflows, Excel + SQL for audit data. Outlined in detail below — build these after Phases 4–5.
No score to fear — this just tells you where to spend extra time. Beginners often score 2–4 / 8.
Tap card to flip •
CPC-style. Answer all 10, then check your domain breakdown. Re-take anytime — your best score is kept in your progress file.
Chart: Established patient, sore throat. Note documents a brief exam, strep test negative, viral pharyngitis impression, 12 minutes total time. Coded as: 99214 + J02.9 with modifier -25 and a separately billed E/M procedure that wasn't documented.
Pick every true audit finding:
Auditor's rule: If it isn't documented, it wasn't done — and time-based E/M must have total time on the date of encounter documented.
For each condition, does the note support an HCC for this year? MEAT = Monitor, Evaluate, Assess/Address, Treat — at least one element, documented for that condition.
| Case | Supports HCC? |
|---|---|
| Diabetes with CKD: “A1c 7.8, continue metformin, kidney labs reviewed, dose adjusted.” | Yes — Evaluate + Treat, linked conditions. |
| COPD: Appears only on the past problem list. Not mentioned in today's visit at all. | No — No MEAT this encounter. Do not code from problem list alone. |
| Heart failure: “HF stable, continue furosemide, weight & edema checked.” | Yes — Monitor + Treat. |
| “Suspect” depression: Provider writes “possible depression, will monitor mood.” No assessment or treatment yet. | No — Suspect conditions are not coded as confirmed in outpatient risk adjustment. |
RADV reality: In a CMS Risk Adjustment Data Validation audit, unsupported HCCs are removed and payments can be extrapolated — that's why MEAT discipline matters more than hunting for more codes.
| Module | You will learn | Practice deliverable |
|---|---|---|
| CDI | Compliant, non-leading provider queries; specificity gaps (e.g., “pneumonia” → organism/type when clinically supported); query response tracking. | Write 5 queries from vague notes without leading the provider. |
| Denials | Denial categories (CO/PR), reading an ERA/EOB & CARC/RARC codes, first-pass appeal letters with documentation attached. | Work 10 denials: classify, fix vs. appeal, write the appeal. |
| Epic / Oracle Health | Where coders actually work: workqueues, charge review, encoder integration, query in-baskets. Concepts transfer even though live system access requires an employer. | Map a claim's journey in each system on paper; learn the 15 most common workqueue holds. |
| Excel for coders | VLOOKUP/XLOOKUP, pivot tables, duplicate & missing-code checks on an audit sample. | Clean a 500-row encounter extract and flag unsupported codes. |
| SQL for audit data | SELECT / WHERE / JOIN / GROUP BY — pull all encounters for a provider, code, or HCC in a date range. | Write 8 queries, e.g. SELECT provider, COUNT(*) FROM encounters WHERE code='E11.22' GROUP BY provider; |
Sequencing note: Don't start Phase 6 until you can pass a CPC practice mock. Tools amplify coding judgment — they don't replace it.
Sources to verify before you pay for anything: AAPC CPC page · AHIMA CCS page · CMS (confirm current exam fees, format, and HCC model year on the official pages — they change).
This is a shareable page, so your progress isn't stored on a server. Your save is a file: export it here, keep it somewhere safe, and import it next time — on any device — to pick up exactly where you left off.