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CPPM AAPC QUESTIONS AND ANSWERS
Which are good options when initiating a difficult conversation? - ANSWER>>Ask: Is this a good time to talk?; Prepare a short statement in advance that gets right to the point, Empathize with the person, Sympathize with the person.
Which is an effective response when a provider is complaining about how hard it is to use the new EMR system the owners of the practice selected? - ANSWER>>This is a major change. I'll do my best to show you how it works.
What is the best description of an office manager? - ANSWER>>Focuses on tactical activités and often have amore directive and controlling appeal AND manages the activities of others.
The difference between efficiency and effectiveness is: - ANSWER>>Efficiency is doing things right while effectiveness is doing the right things.
Staff accountability is best achieved by: - ANSWER>>Assigning object goals; assigning measurable goals; define the responsibility for tasks.
When should the staff obtain a photocopy of the patients insurance card? - ANSWER>>When the patient arrives for their appointment
Which of the following is the best example of communicating in a difficult conversation? - ANSWER>>Let the person know, "I understand how you feel."
Which of the following are benefits of using a mid-level provider? - ANSWER>>Improved revenue; improved patient satisfactions; greater access to care for patients.
An established patient did not keep her scheduled appointment. There is or record that she called to cancel or reschedule. This is her third "No show" in one year. Based on the No-show policy, which of the following process should be followed? - ANSWER>>Suspend services temporarily.
Which of the following is a road-block to active listening? - ANSWER>>Give advice that is not asked for
What is the best way to handle a verbal attack? - ANSWER>>Listen
Which of the following includes the payment amount and denial explanations for claims submitted. - ANSWER>>Explanation of Benefits (EOB)
Your office recently installed a new phone system. Training was provided to the staff and the physicians. One of the physicians can't seem to get the hang of it and is continually disconnecting his calls. He calls you into his office and blames you for the faulty phone system and his inability to learn how to use it. Using good communications skills, you would" - ANSWER>>Be quiet and listen to all his concerns
Which of the following services would bet the most profitable and efficient use of mid-level provider in a. physician's office and meets incident-to rules? - ANSWER>>Sees established patient for follow-up visits of established conditions.
A patient is returning today for her second injection of denosumab for postmenopausal osteoporosis. To achieve the best staff efficiency which of the following staff members should perform the injection? - ANSWER>>Medical Assistant
Which providers may write prescriptions? - ANSWER>>Physician's Assistant; Nurse Practitioner
The front desk plays an important role in: - ANSWER>>Customer service, Optimizing physician time, Claim quality assurance
Medicare offers plans for Part A, Part B, Part C, and Part D. Which of these covers inpatient hospital care? - ANSWER>>Part A
A MEDICARE PATIENT IS SEEN IN THE URGENT CARE CLINIC FOLLOWING A MINOR AUTOMOBILE ACCIDENT. THE PATEITN HAS MEDICARE PART A, B,AND C AS WELL AS No-FAULT THROUGH ATUO INSURANCE. WHO IS THE PRIMARY INSURANCE? - ANSWER>>Automobile No-fault
Which is a common reason for denials? - ANSWER>>The service is not medically necessary.
You work for. a pediatric office and the parents of a patient inform you they can No longer afford halter insurance. They do not qualify for Medicaid as their income is too high. What would you recommend? - ANSWER>>Apply for CHIP coverage
Procedure codes are reported by the facility using which code set? - ANSWER>>ICD-10-PCS - Inpatient Hospital Facilities. Only submitted by FACILITIES!
Posting payment and collection policies in a prominent place in your office has what benefit? - ANSWER>>Prepares the patient to make proper payments at the time of service.
There are many elements to a successful appeals process. What is the first and most important process? - ANSWER>>Analyze the reason for the denial.
Which of the following services is covered by Medicare Part B? - ANSWER>>Physician services
Which services meet medical necessity? - ANSWER>>A lipid panel for a patient with high cholesterol
A claim form that is complete and accurate and includes all provider information, member information and other additional information needed to process for payment is called? - ANSWER>>A clean Claim
The Place of Service (POS) code on a claim form is important to determine correct reimbursement. Which statement is correct? - ANSWER>>The professional component for services provided in a facility (for example, hospital or ASC) are less than when provided in the physicians office because the physician does not have any practice expense at the facility like rent, staff, and supplies.
When reviewing denials, your biller notices that one fo the private payers is not paying for venipuncture when performed during an office visit. What should be done? - ANSWER>>Check the payer contract to see if the denial is appropriate
In which kind of a scenario is Medicare the secondary payer? - ANSWER>>A patient who requires surgery for a fracture hip as a result of a car accident - auto insurance becomes primary payer.
When should credentialing of a provider be performed? - ANSWER>>When it is determined the physician will be hired
What is the most important criteria to meet for the selection of Evaluation and management codes? - ANSWER>>Medical Necessity
An ABN form is used to: - ANSWER>>Notification to patient That Medicare may not cover a certain procedure or service
Claim denials or delays can Be caused by inaccurate data. What type of denials should the practice management look for that indicate a potential training need for data entry? - ANSWER>>Information gathered at the time of registration is paramount for clean claims submission, authorizations for services, and future collection efforts.
When performing a registration audit, what should you look at? - ANSWER>>Address, phone numbers, employer, insurance verification, Copay collected.
When a practice sees revenue fluctuating, the factors most often at the heart of the decreases are: - ANSWER>>Patient Volume, Staff delays and errors, coding delays and errors, billing delays and errors, insurance delays.
What payments should be collected by the front desk? - ANSWER>>Any payment the patient is responsible for
A timely filing deadline is - ANSWER>>An amount of time stipulated by the insurance carrier contract to file a clean claim
Which of the following would be a best practice for a new patient to your office? - ANSWER>>Gather as much information as possible prior to the visit
Which is a vital component to proper medical coding? - ANSWER>>Codes based on complete and accurate medical record documentation in the patients chart
What is a benefit of an ERA (Electronic remittance advice)? - ANSWER>>Save staff time and reduce data entry errors
Medicare uses RBRVS to determine reimbursement rates. What are the three factors used to calculate a rate for each CPT? - ANSWER>>RVU, GPCI, CF
What are three key indicators in monitoring receivables? - ANSWER>>Measure the net collection rate, monitor denials, measure the A/R days
What is an important piece of the revenue cycle? - ANSWER>>Appointment Scheduling
What are three component that are necessary to have a claim paid correctly by the payer? - ANSWER>>Procedure codes, diagnosis codes, and insurance policy number
Which statement is true regarding prior authorizations? - ANSWER>>Someone who can effectively communicate clinical significance to the payer should obtain the prior authorization.
Which of the following is essential for accurate charge capture? - ANSWER>>Review documentation of the services to make sure all codes are reported.
Which of the following best describes when accounts should be sent to a collections agency? - ANSWER>>Any patient account over 90 days old with a balance over $10.
What instances below can add to an inefficient bad debt management process?
- ANSWER>>Numerous clinical and administrative approval requirements, unclear policies on write off thresholds, unclear policies that limit the amount of balance billing
Which of these methods is not recommended for collecting payment from insurance payers? - ANSWER>>Provide a discount if payment is received by a certain date.
What should bank deposit be balanced against? - ANSWER>>Deposit slips from the bankd
Five physicians are setting up a group practice. They want to be able to issue stock as to a limited number of shareholders and where net income is not taxed at the entity level but flows through the physicians personal income tax return. Which corporate structure would best suit their needs? - ANSWER>>S Corporation
What is considered accounts payable? - ANSWER>>Refunds due to patients for over payments on their account
Which of the following options would be the most beneficial in managing costs?
- ANSWER>>Participation in a GPO
When reviewing an income statement, what is the term that refers to the profit the practice made over a specific time period? - ANSWER>>Net Income
Which of the following is a trend in health care that can be expected with health care reform? - ANSWER>>The focus of care will shift from acute care to preventative care and wellness
Which MIPS component is calculated based on Medicare Spending per Beneficiary, total per capita costs, and condition and treatment episode-based measures? - ANSWER>>Cost
A provider is a part of the Quality Payment Program if: - ANSWER>>The provider is in an APM (Advanced Payment Model) or bills more than $30,000 in Part B allowable charges and sees more than 100 Medicare patient sin a year
President Obama signed into law the comprehensive health reform legislation known as: - ANSWER>>Patient Protection and Affordable Care Act
What is an Alternative Payment Model (APM)? - ANSWER>>Risk-bearing contracts that require a provider to put up more than a nominal financial risk.
Which option is NOT a goal of the Medicare Access and CHIP reauthorization Act of 2015 (MACRA)? - ANSWER>>Provide new and innovative ways for providers to expand offerings to patients.
What are the primary objective of the Affordable Care Act? - ANSWER>>1. Expanding Health Coverage, 2. Controlling Healthcare Costs, 3. Modernizing the healthcare delivery system
Which statement is TRUE regarding fraud and abuse provisions of the PPACA? - ANSWER>>Providers are required to supply, upon request, documentation of DME and home health referrals.
MIPS data for advancing care information is based on the CEHRT edition used. Which editions were available as options? - ANSWER>>2014 & 2015
The ACA health legislation enacts several provisions on insurance companies that are aimed at improving customer safeguards. Which provision is NOT included in the health reform? - ANSWER>>Allows insurance to increase rates based on pre-exisiting conditions.
What are some of the key trends addressed in healthcare reform? - ANSWER>>Healthcare is being targeted for major IT transformation, Shift from acute care to prevention and wellness, changing roles of physicians, care delivery will expand beyond the traditional physician office, coordination of care, focus on fraud and abuse, coding and documentation advancement
Which MIPS component is designed to improve clinical practice or care delivery leading to improved outcomes? - ANSWER>>Improvement Activities
included in the fraud and abuse provision? - ANSWER>>Providers are required to supply, upon request, documentation of DME and home health referrals.
Which of the following are benefits for initiating quality efforts in a practice? - ANSWER>>Reduce the risk of medical law suits, improve patient satisfaction, strengthen stability of the business, makes it twice as easy to recruit staff and providers. Safe, effective, Patient Centered care who is timely, efficient and equitable.
Quality improvement focuses on - ANSWER>>Refining process to reach higher levels of quality
Which is an example of a practice monitoring quality assurance? - ANSWER>>Internal audit of billing procedures to verify compliance with federal and state regulations
What is the main similarity between quality assurance and quality improvement? - ANSWER>>Address work flow
Which of the following is the best example of quality control? - ANSWER>>Lab equipment calibration
Which would be elements of a PDCA (Plan-Do-Check-Act) cycle? - ANSWER>>A quality cycle and quality improvement method, requires a benchmark so the team understands the goal for improvement, review the original benchmark data to determine if improvements are made
Plan-Do-Check-Act is defined as - ANSWER>>A quality cycle and QI method that systematically impacts a process or system
Where can you find external benchmarks for concurrent medical practices? - ANSWER>>MGMA surveys
Quality Care improvement includes which of the following? - ANSWER>>Provide services based on scientific knowledge
Which of the following is an example of how IT can help reduce medical errors?
- ANSWER>>Computerized order entry for radiology tests
When determining the scanning equipment process, which statement is best to keep in mind? - ANSWER>>Better scanners cost more money, but will usually pay for themselves in time spent quickly when converting large volumes of paper records to electronic files.
What are some financial implications of implementing an EMR system? - ANSWER>>Purchase of software, Training staff, Upgrade Costs, Ongoing support
What act is part of the ARRA and includes an incentive payment program? - ANSWER>>HITECH
The practice currently scanning insurance cards for every visit. Practice it running out of storage space on the server. What is the best solution? - ANSWER>>Require the front desk to verify the copy in the EMR and only scan if something has changed with patients insurance/
Who oversees the Health IT certification program for EHRS and Health Information Exchanges? - ANSWER>>Office of the National Coordinator for Health Information technology
Which statement is TRUE regarding program interacting? - ANSWER>>Interfacing is necessary to reduce duplicate entries of demographic information
When reviewing the communication process of an EMR, which would reflect a good plan? - ANSWER>>Messaging sent to a provider regarding a patient should have the ability to attach to the patients chart.
What is Telehealth/telemedicine? - ANSWER>>A process by which medical care can be provided remotely through electronic media that does not include having a care provider physically present during the evaluation
What types of stored data can be used for electronic querying and reporting? - ANSWER>>Structured Data
The most common language used to communicate between internal applications and other facilities is called - ANSWER>>HL
What are examples of services included in interoperability of electronic date in the ambulatory setting. - ANSWER>>DME, Lab Test, Referrals to other providers, Medications
A patient has filed a workers comp claim. The employer request the medical records. Can the provider send the medical records without authorization from the patient? ` - ANSWER>>YES - If the employee is a member of the workplace, and it is concerning a workplace injury, the records can be released.
A billing office, has used EOBS in an educational setting. Is this a violation of HIPAA? - ANSWER>>Yes, business associates are required by HIPAA and by their BAA agreement to protect PHI
The security rule requires passwords. What is the most secure? - ANSWER>>Pas$
What is considered a Business Associate (BA)? - ANSWER>>Billing companies, Software vendors, Consultants, transcriptionists
Billing remotely from home. What would be a reasonable safeguard? - ANSWER>>Require the employee to log on to a remote server that has an automatic logoff feature set.
What has been implemented through HIPAA Laws - ANSWER>>Privacy, security, transactions and code sets, provider identifiers
Why was HIPAA enacts? - ANSWER>>To simplify the administration of health insurance
How do you provide an auditor access from home? - ANSWER>>Authentiation and digital signatures
What does administrative Simplification include? - ANSWER>>Privacy rule, code sets, security rule, electronic transactions, identifiers
Minimum necessary standards - ANSWER>>Limiting access to the medical records to only those employees who need it for a specific purpose.
Which list best represent what is included in business continuity and disaster recovery panning? - ANSWER>>Staff-patient communications, where staff and patients will go, fire exits and how staff will continue to do their job.
What do you need to ensure patient safety in the event of a disaster? - ANSWER>>Plan business continuity, a management plan, recovery resources to safeguard operations and ensure patient safety.
Which option would be the best policy for the back-up of your practice management and MER systems? - ANSWER>>Back-up the systems daily and store the back-up tape off-site.
Which option would not be included in a post-disaster checklist? - ANSWER>>Remove unsalvageable equipment immediately - wait for adjuster!
In the context of precautionary measures, what is a system of mirrors? - ANSWER>>Planned Redundancies
What are examples of operational workflows? - ANSWER>>Process for checking in, scheduling, services provided
Included in the business workflow are activities that verify - ANSWER>>Accurately coded encounters, completed medical records, identifying when a claim is not paid promply
What would be an effective way to manage drug samples within an office? - ANSWER>>Keep a drug sample closet that is locked and requires documentation of samples provided to patients.
What is best for an automated attendant in telephone triage system? - ANSWER>>Limit number of options with clear, simple direction
Employees can make a difference in the appearance of the office by: - ANSWER>>Picking up garbage and straightening chairs, wipe smudges from windows.
What does a good compensation plan include? - ANSWER>>A pay scale that takes into consideration the industry standards and adjusts for years of service, special training and other benefits.
which physician compensation model requires allocation of revenue and expenses to each physician in the practice? - ANSWER>>Income Statement model
What can you legally ask about in an interview - ANSWER>>Citizen of the US, Convicted of a crime, Education level, Worked under different name - No age, race, ethnicity, religion, disability
What physician compensation mode is based on the work value for each procedure? - ANSWER>>Relative Value unit (RVU) model
Which benefits has federal regulations that directly tie the physicians benefit to employees benefit - ANSWER>>Profit Share Plan
Which cannot be used to base firing or hiring of an employee? - ANSWER>>Age
When developing a physician compensation plan, the main consideration should
- ANSWER>>Align with the organizations strategic goals
What types of questions should be asked when interviewing and why? - ANSWER>>Yes/No questions fo verify date and other objective information. Open-Ended questions to evaluate how an employee would respond to particular situations
Which option below would be the most effective interview question about employee conflict resolution? - ANSWER>>In the past, when in conflict with another employee, how was the conflict resolved?
Which statement best describes an effective marketing plan? - ANSWER>>Creating a service that is of interest to patients and then effectively communicating these services to them
As a new manager, you oversee implementing a marketing plan. When you would implement it? - ANSWER>>After you have the right people and good processes/systems in place
Which is most effective for increasing revenue streams in the practice? - ANSWER>>Consider new ancillary services in the clinic
What laws should you consider before purchasing big equipment with high reimbursement rates? - ANSWER>>Stark and Anti-Kickback
Where do you start with marketing? - ANSWER>>Verify good systems, right people and culture, provides quality services
