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CPPM Final Exam Study Guide – Certified Physician Practice Manager (comprehensive revision and exam preparation material) Which of the following is NOT a typical duty of a practice manager? a. Implement strategies to reduce the A/R b. Inventory control for supplies needed for minor surgeries c. Fostering a referral source for new patients d. Preparation of the patient for the physician - correct answer ✔✔Preparation of the patient for the physician Which of the following includes the payment amount and denial explanations for claims submitted? a. Denial reconciliation report b. Accounts receivable report c. Explanation of benefits (EOB) d. Encounter form - correct answer ✔✔Explanation of benefits (EOB) You work for a primary care practice. A patient has recently suffered a transient ischemic attack (TIA) and your physician wants to send the patient to a specialist for a consultation. Which specialty would handle this type of diagnosis? a. Infectious disease b. Endocrinology c. Rheumatology d. Neurology - correct answer ✔✔Neurology A physician assistant (PA) is hired by a cardiology practice to help see patients in the hospital. The PA performs all the rounds and notifies the physician on call if there are any patients that need to be seen by a physician. Is it appropriate to bill for the PA's services as incident-to?
a. No, incident-to services are not covered in a hospital setting. b. Yes, as long as the physician sees the patient later in the day. c. Yes, as long as the services are consistent with an established plan of care. d. No, the physician needs to see every patient in order to bill incident to. - correct answer ✔✔No, incident-to services are not covered in a hospital setting. What is a good way to improve efficiency and accuracy in the registration process? a. Mail an invoice rather than collect at time of service. b. Audit two records per staff member every year for accuracy. c. Scan a copy of the patient's insurance card. d. Email audit results to staff members with instructions to improve. Training takes up too much time. - correct answer ✔✔Scan a copy of the patient's insurance card. What percentage of communication occurs through body language? a. 35 b. 85 c. 55 d. 15 - correct answer ✔✔ 55 Which of the following is the best example of communicating in a difficult conversation? a. Arguing or disagreeing with the speaker. b. Let the person know, "I understand how you feel." c. Let the person know, "It's going to be alright."
b. MS-DRGs c. APCs d. NPI - correct answer ✔✔MS-DRGs A common billing error is invalid or truncated ICD-10-CM codes. How can you prevent this? a. Always use the code selected by the provider. b. Only use codes with seven characters. c. Make sure the code on encounter form matches the code that is billed. d. Update the practice management system when new, deleted, and revised codes are released. - correct answer ✔✔Update the practice management system when new, deleted, and revised codes are released. Which option is a common reason for denials? a. The provider is credentialed with multiple insurance carriers. b. The patient's insurance was terminated following a service. c. The patient did not show for a scheduled appointment. d. The service is not medically necessary. - correct answer ✔✔The service is not medically necessary. Which of the following is a chronological description of the development of the patient's complaints? a. Medical decision making b. History of present illness c. Chief complaint d. Medical necessity - correct answer ✔✔History of present illness Common performance indicators for charge entry include:
I. Days to enter charges II. Consent to treat III. Missing charges IV. Coding accuracy V. Account balance collected a. I, II, III, IV, and V b. II, III, and IV c. I, III, and IV d. I, II, and IV - correct answer ✔✔Days to enter charges Missing charges Coding accuracy In reviewing the A/R report showing a list of charges, adjustments, collections, and A/R balance by month, which statement is TRUE? a. Collections drop significantly during the summer months (June-Aug.). b. The amount of payments is increasing. c. The accounts receivable is on a worsening trend. d. Progress is being made in lowering the accounts receivable balance. - correct answer ✔✔Progress is being made in lowering the accounts receivable balance. What factors should a practice manager look at if there is a decrease in the revenue of the clinic? a. Patient volume and insurance delays b. Staff delays and errors c. Coding and billing delays d. All of the above - correct answer ✔✔Patient volume and insurance delays Staff delays and errors
What describes the key component for compliance with medical coding standards? a. Use only the current year code sets. b. Complete and accurate medical record documentation in the patient's chart. c. Obtain prior authorization on all services. d. None of the above. - correct answer ✔✔Complete and accurate medical record documentation in the patient's chart. What is a benefit of an electronic remittance advice (ERA)? a. Automated resubmission of claims with corrected information. b. Claims are submitted electronically, therefore payment is received quickly. c. Save staff time and reduce data entry errors. d. An ERA will verify the contracted rate. - correct answer ✔✔Save staff time and reduce data entry errors. ?? A practice manager uses several reports to monitor the health of the practice. What report is used to monitor the amount and type of services provided in the practice? a. Productivity report b. A/R aging report c. Net collection rate report d. Denial report - correct answer ✔✔Productivity report What should deposits on your bank statement be balanced against? a. Net receipts b. Each provider's personal bank statement c. Patient accounts
d. Deposit slips from the bank - correct answer ✔✔Deposit slips from the bank Based on chart 1, what would be the revenue goal for a clinic wanting to make enough to cover all of their costs? a. $500, b. $850, c. $700, d. $350.000 - correct answer ✔✔$500, When reviewing an income statement, what is the term that refers to the profit the practice made over a specific time period? a. Total income b. Cash from operations c. Net income d. Equity - correct answer ✔✔Net income In developing a budget, which of the following should be considered? I. Balance sheet II. Chart of accounts III. Expenses from the current/past year IV. Purchasing contracts V. Physician compensation contracts a. II, III, IV, and V b. I, IV, and V c. II and III d. I, II, and III - correct answer ✔✔Balance sheet Chart of accounts
d. In order to prepare to offer Botox® in September, the practice purchases the supply in August and reports the revenue in August. - correct answer ✔✔In order to prepare to offer Botox® in September, the practice purchases the supply in August and reports the expense in August. Which of the following should NOT be counted as revenue? a. Income received for work performed for a clinical trial b. Marketing fees c. Honorarium for speaking at a medical conference d. Finance fees collected from the insurance carrier for untimely payments - correct answer ✔✔Marketing fees Value-based purchasing is a reimbursement model that pays hospitals based on performance around the following: I. Patient satisfaction scores II. Quality of care III. Efficiency IV. Return on investment V. Number of physicians employed a. I, II, and III b. II, III, and V c. I an IV d. II and V - correct answer ✔✔Patient satisfaction scores Quality of care Efficiency The future of healthcare will likely see a shift from acute care to prevention and wellness. True or False.
a. False. Focus is trending more toward specialized acute care to treat only current, active problems. b. True. Preventive care visits are on the rise; as a result health insurance is redesigning the benefits offered. c. False. Providers will need to turn to more specialized care requiring patients to have office visits for all care. d. True. There is a growing trend among employers and insurers providing disease management programs to provide interventions for people who have modifiable risk factors. - correct answer ✔✔True. There is a growing trend among employers and insurers providing disease management programs to provide interventions for people who have modifiable risk factors. The objective of an ACO is to minimize incentives that promote quantity of care by realigning incentives between: a. Providers and hospitals to decrease the number of tests required to determine a diagnosis b. Providers and hospitals to better coordinate care and improve efficiency c. Patients and hospitals to better coordinate care and use less home health services d. Providers and patient to better coordinate care and improve efficiency - correct answer ✔✔Providers and hospitals to better coordinate care and improve efficiency President Obama signed into law the comprehensive health reform legislation known as: a. Cost Reduction and Quality Improvement Act b. Patient Protection and Affordable Care Act c. Consolidated Omnibus Budget Reconciliation Act d. Health Insurance Portability and Accountability Act - correct answer ✔✔Patient Protection and Affordable Care Act
b. Do c. Check d. Act - correct answer ✔✔Check Which of the following are specialty sets under MIPS Quality? I. Diagnostic radiology II. Podiatry III. Preventive medicine IV. Pathology V. Pediatrics a. I, II, IV, and V b. V only c. II and V d. I, II, III, IV, and V - correct answer ✔✔I. Diagnostic radiology II. Podiatry III. Preventive medicine IV. Pathology V. Pediatrics A physician's office with two full-time physicians and four full-time nurse practitioners currently has two coders on staff to perform all the coding for the practice. The coder's state they need additional help to stay current and the physicians state they should be able to keep up with the current staff. Where would you look to find benchmark information on how many coders should be on staff? I. MGMA surveys II. OSHA compliance manual III. The Joint Commission
IV. EMR statistics a. I, III, and IV b. I and IV c. I and III d. I, II, III, and IV - correct answer ✔✔MGMA surveys The Joint Commission ?? What is the main similarity between quality assurance and quality improvement? a. Do not affect people b. Integrated system to address processes c. Continuous refining of processes d. Address workflow - correct answer ✔✔Address workflow Quality improvement focuses on: a. Information technology issues b. Refining process to reach higher levels of quality c. Constant training d. Individual clinicians or system users - correct answer ✔✔Refining process to reach higher levels of quality Which of the below are elements of a PDCA cycle? I. A quality cycle and quality improvement method II. Requires a benchmark so the team understands the goal for improvement III. PDCA is an informal approach to QI IV. Review the original benchmark data to determine if improvements are made
Which option below is an effective way to ease the transition to EMRs for providers? a. Provide a super user to shadow the physician the first days or week after going live so they can confidently answer any questions that come up during use. b. Hire scribes for each physician to record all documentation for each provider. This allows providers to solely focus on patients and not documentation. c. Allow physician's to remain with paper charts, but hire scanners to scan them in at the end of each day. d. Require the physician to allow for an additional 2-3 hours at the end of each day so they can enter the charts into the medical record that were recorded on paper earlier during the day. - correct answer ✔✔Provide a super user to shadow the physician the first days or week after going live so they can confidently answer any questions that come up during use. There are costs of an EMR that go beyond implementation costs. Of the following, which cost goes beyond implementation? a. Increased electric costs b. Overtime costs for employees c. Ongoing support and software upgrade costs d. None of the above - correct answer ✔✔Ongoing support and software upgrade costs Under which option can a provider submit a QPP Exception Application? a. MIPS-eligible clinician using 2015 CEHRT b. Insufficient Internet connectivity c. MIPS-eligble clinicians in large group practices d. MIPS-eligible clinican using 2020 CEHRT - correct answer ✔✔Insufficient Internet connectivity
What application of an EMR will generally require the least amount of IT staff in a clinic for software updates and redundant backups of the data? a. ASP (Cloud Based) b. HITECH approved c. Interfaced with other systems d. Client-server configuration - correct answer ✔✔ASP (Cloud Based) According to the national alliance for health information technology, the difference in an EMR and EHR is: a. Electronic data stored in one practice versus cumulatively across more than one health care organization b. The total number of users in the system c. No difference; just different ways of saying the same thing d. One includes labs and prescriptions and the other does not - correct answer ✔✔Electronic data stored in one practice versus cumulatively across more than one health care organization Who oversees the Health IT Certification Program for EHRs and Health Information Exchanges? a. Centers for Medicare & Medicaid Services b. Private companies designated by U.S. Department of Health & Human Services c. Office of Inspector General d. Office of the National Coordinator for Health Information Technology - correct answer ✔✔Office of the National Coordinator for Health Information Technology ?? What is the purpose of Clinical Decision Support Systems?
Benefits of e-prescribing services and functions include which of the following: a. Increased revenue for the practice b. Guaranteed prevention of fraudulent prescriptions c. Point of care provider access to the patient's payer formulary d. Elimination of patient reactions to medication - correct answer ✔✔ Health Information Exchanges (HIE) are managed by Health Information Organizations (HIO). What type of HIOs can manage an HIE? a. Collaborative, cooperative, public b. Registered, collaborative, proprietary c. Proprietary, cooperative, private d. Private, public, cooperative - correct answer ✔✔ Enterprise Architecture considers: (select all that apply) a. Human resources b. Data Management c. Business Goals and Processes d. Software applications e. IT hardware - correct answer ✔✔ The HIPAA law defines a business associate as anyone who performs a function, activity, or service on behalf of a covered entity or organized healthcare arrangement involving the use and disclosure of protected health information. Which of the following are considered business associates? I. Credit unions II. Billing companies III. Software vendors
IV. Banking institutions V. Consultants VI. Transcriptionists a. I, II, III, and IV b. III, IV, V, and VI c. II, III, IV, and V d. II, III, V, and VI - correct answer ✔✔ What would be considered a proper notice of breach under the HITECH law when under 500 individuals were affected by the breach and at least a dozen patient addresses are out of date? a. Call everyone affected by the breach and inform them of the date of the breach and when it was discovered, a list of names included in the PHI, and suggested steps for individuals to take to protect themselves against any problems stemming from the breach. b. Send a breach notice via U.S.P.S. with a date of the breach, when it was discovered, along with a copy of the information that was breached. c. Publish a print advertisement of the breach in the local paper and include the date of the breach and when it was discovered, a brief description of incident that led to the breach, description of the unsecured PHI involved, and suggested steps for individuals to take to protect themselves against any problems stemming from the breach. - correct answer ✔✔ The HITECH breach notification rule has several notice requirements. Which of the below are notice requirements? I. Notify the media if more than 250 individuals' information has been breached II. The date of the breach III. When the breach was discovered IV. The notice must be received in 30 days V. Description of unsecured PHI
