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CPPM Exam Prep – Comprehensive Study Guide
(Certification in Physician Practice Management)
Revenue Per Visit (RPV) - correct answer ✔✔Total amount collected divides by the total number of patient visits Advance Benefit Notification (ABN) - correct answer ✔✔Notification given to patients advising Medicare may not cover a certain procedure or service Payment for fee for service is based on - correct answer ✔✔CPT & HCPCS Level II MCO - correct answer ✔✔Private Health Plan Place of Service (POS) determines correct reimbursement when - correct answer ✔✔The professional component for services provided in a facility (I.e. HOD) are less than when provided in a physician office as the physician doesn't have any practice expense at the facility. (In private practice they pay rent, staff etc whereas is HOD these are paid by the facility) DEA number - correct answer ✔✔Is not needed for the online application to CMS for an NPI Customer service, optimizing physician time and claim quality assurance are key components to which role? - correct answer ✔✔Front Desk What can result in claim denial? - correct answer ✔✔Incorrect POS, incorrect NPI, and a truncated diagnosis code
Patients are prepared to make payments at the time of there visits when? - correct answer ✔✔Payment & collection policies are prominently posted in the office What is the most important criteria to meet for the selection of Evaluation and Management (E/M) codes? - correct answer ✔✔Medical necessity What code set represents healthcare equipment, drugs and supplies? - correct answer ✔✔ICD-10.PCS ICD-10-CM - correct answer ✔✔International Classification of Diseases, Tenth Revision, Clinical Modification CM codes represent the diagnosis/reason a service is performed. ICD-10-PCS - correct answer ✔✔International Classification of Diseases, Revision Procedural Coding System. These represent procedures performed at inpatient hospital facilities CPT codes - correct answer ✔✔current procedural terminology represent procedures performed & bilked by physicians and non-physicians practitioners (APP's) HCPCS Level II - correct answer ✔✔for products and supplies and services not included in level I. the code is alphanumeric Clean Claim Form - correct answer ✔✔A form that is complete and accurate and includes all provider information and other additional information to process for payment History of present illness - correct answer ✔✔Chronological description of the development of patients complaint
What accounts should be considered for collection? - correct answer ✔✔90+ days with a balance greater than $ What should you consider when conducting a registration audit? - correct answer ✔✔Address, phone #, employer, insurance verification, and co-pay collected Three indicators for monitoring receivables - correct answer ✔✔Net collection rate, denials, and A/R days Three components to having claims paid by payer - correct answer ✔✔Procedure code, diagnosis code(s), and insurance policy number What payments should be collected by the front desk - correct answer ✔✔Any balance due that is the patients responsibility Which denials should be a priority? - correct answer ✔✔Inclusive service as this is typically the highest dollar amount. To verify the validity, check the payers bundling edits and payer contracts. What report and/or measurement identifies how well a practice collects on allowable charges - correct answer ✔✔ Common performance indicators for charge entry includes - correct answer ✔✔Days to enter charges, missing charges, coding accuracy Prospective Fee Schedule - correct answer ✔✔The type of reimbursement used by payers to pay a predetermined set amount for each procedure code What tools should be considered when developing a budget? - correct answer ✔✔Balance sheet, chart of accounts and expenses from current/past year
Refunds due pts for overpayment on their accoitn - correct answer ✔✔Accounts payable S corporation - correct answer ✔✔Similar to a C corp as they can issue stock but limited to the # of shareholders. All profit must be distributed in proportion to ownership %. Net income is not taxed at the entity level rather flows through the physicians personal tax return. What tool is used to determine where costs could be made? - correct answer ✔✔Income statement Cash-based Accounting System - correct answer ✔✔When purchases and expenses are reported the same month even if not being used until future dates. Marketing fres - correct answer ✔✔not reveue Cash Flow Statement - correct answer ✔✔A financial statement that shows the flow of money in and out of the business. What is the benefit of involving staff in a meeting to discuss reducing costs - correct answer ✔✔They maybe creative In cost savings measures to protect their jobs What is the advantage Of leasing equipment? - correct answer ✔✔Leased payments are deductible for income tax purposes Is the use of a budget useful to monitor the debt to equity ratio? - correct answer ✔✔No
What will be needed to meet the demands of the patients that result from an expansion of Medicaid and mandated insurance coverage? - correct answer ✔✔An increase in the use of mid-level providers Which MIPS component is calculated based on Medicare spending per beneficiary, total per capita costs and conditions and treatment episode- based measures? - correct answer ✔✔Cost The objective of an ACO is to minimize incentives that promote quantity of care by realigning incentive balances between - correct answer ✔✔Providers and hospitals to better coordinate care and improve efficiency What is a trend in healthcare that can be expected with healthcare reform? - correct answer ✔✔The focus of care will shift from acute care to preventive care and wellness Which MIPS component is designed to improve clinical practice or care delivery leading to improved outcomes? - correct answer ✔✔Improved activities The state-based insurance exchange for small businesses (SHOP) stands for - correct answer ✔✔Small business health options program MIPS data for advancing care information is based on the CEHRT edition used. Which additions were available as options? - correct answer ✔✔2015 & 2016 A part of the initiate cost control. There is a focus on fraud and abuse reform by HHS, OIG, FBI, Medicare and Medicaid and DOJ. Which of the following is included in the fraud and abuse provision? - correct answer ✔✔Providers are
required to supply upon request documentation of DME and home health referrals The new health legislation and ask several provisions uninsured companies that are aimed at improving customer safeguards. Which provision is not included in the health reform? - correct answer ✔✔Requires health plans to spend 75% or more of the premium dollars on medical related services Which provisions of the PPACA will reduce fraud and abuse? - correct answer ✔✔Allow sharing of IRS data so I don't to five fraudulent providers or providers with tax debts What is an Alternative payment model? - correct answer ✔✔Risk bearing contracts that require a provider to put up more than a nominal financial risk. MACRA provides automatic, annual payment increases of 0.5% for all doctors through what year? - correct answer ✔✔ 2019 Is providing new and innovative ways for providers to expand offerings to patients a goal of the Medicare access and CHIP reauthorization act of 2015?
- correct answer ✔✔No Key elements of change management - correct answer ✔✔Embrace the change, define the future, and engage everybody. It is not necessary to train all staff. What is an ACO? - correct answer ✔✔A group of doctors and hospitals who, as a team, agreed to be responsible for a patient's overall care What are the primary objectives of the affordable care act? - correct answer ✔✔Expanding health coverage, controlling healthcare costs, and modernizing the healthcare delivery system
According to the national alliance for health information technology, the difference in an EMR and EHR is what? - correct answer ✔✔Electronic data stored in one practice versus cumulatively across more than one healthcare organization Which option is an effective way to ease the transition to EMR's for providers
- correct answer ✔✔Provide a super user to shadow the position the first days or week after going live so they can confidently answer any questions that come up during use When reviewing the communication process of an EMR, which option would reflect a good communication plan for an EMR? - correct answer ✔✔Break even analysis Fixed costs + annual equipment cost/ revenue per unit - total fixed cost - correct answer ✔✔ Value-based purchasing is a reimbursement model that pays hospitals based on performance around the following items - correct answer ✔✔Patient satisfaction scores, quality of care, and efficiency What ways can IT help reduce medical care hours - correct answer ✔✔Computerized order entry for radiology test During which phase of plan, and do, check and act would be necessary for staff to discuss the success of a new process and potential issues? - correct answer ✔✔Check What are the elements of a PDC a cycle? - correct answer ✔✔A quality cycle and quality improvement method, a benchmark so the team understands the
girlfriend provement, review of the benchmark data to determine if improvements are made What specialty Does not fall into the MIPS quality - correct answer ✔✔Podiatry Quality control - correct answer ✔✔A system of technical activities that measures against criteria for standard What is an example of quality control - correct answer ✔✔Lab equipment calibration What would you use for a benchmark information for coda ratio per medical staff? - correct answer ✔✔MGMA surveys True or false: Quality assurance includes activities that sure is service is of the type and quality needed an expected by the user - correct answer ✔✔True What is necessary to achieve the highest scores for the MIPS quality component? - correct answer ✔✔A minimum of six measures including at least one outcome or high priority measure What does quality improvement focus on - correct answer ✔✔Refining process to reach higher levels of quality What are examples of telemedicine? - correct answer ✔✔Image transfers, medical education, monitoring of vital signs, and nursing call centers
What are the notice requirements of a HITECH breach? - correct answer ✔✔The date of the breach, when the bitch was discovered, description of unsecured PHI What are the best practices for data security? - correct answer ✔✔Frequent changing of passwords, secure computer room, transaction trail thought it Why was HIPPA enacted? - correct answer ✔✔To simplify the administration of health insurance Why can a provider send the medical records to an employer without an authorization when there is a Worker's Compensation claim? - correct answer ✔✔The employee is a member of the workplace and it's concerning a workplace injury there for the records can be released What is proper notice of breach under the HITECH law went under 500 individuals were affected by the breach and at least a dozen patient addresses are out of date? - correct answer ✔✔
