Download CPPM Practice Exam – Certified Physician Practice Manager (full-length practice test and e and more Exams Advanced Education in PDF only on Docsity!
CPPM Practice Exam – Certified Physician Practice Manager (full- length practice test and exam preparation guide) Which of the following scenarios is appropriate incident-to billing? - correct answer ✔✔D. A physician's assistant at an OB/GYN practice sees patients for their follow up OB appointments while the physician sees new OB patients in the office. In the practice you manage, the medical assistants are responsible for preparing the patients for the physician. The medical assistants place a green folder in the door so the physician knows which patient is next to be seen. The physician refuses to follow the system and determines who he will see next, which is angering the patients because they are waiting too long in the exam room. The medical assistant is extremely upset and close to tears. Which of the following responses is an example of effective communication in this situation? - correct answer ✔✔B. "I understand your frustration. Since this system does not appear to be working, what do you suggest?" During the typical patient flow for an encounter, when should the copayment be collected? - correct answer ✔✔A. When the patient checks in with the front desk prior to the appointment. Which of the following is NOT a typical duty of a practice manager? A. Developing a strategy to increase patient referrals. B. Inventory control for vaccines needed for school physicals. C. Processing prior authorizations for minor surgeries performed in the office. D. Implement strategies to reduce the days in A/R. - correct answer ✔✔C. Processing prior authorizations for minor surgeries performed in the office. Which statement regarding insurance reform is TRUE? A. A requirement to permit adult children to stay on family policies until age 26.B. Require pre-authorizations for only emergency department services.C.
Limit the lifetime limits on the dollar amount of the coverage for which insurers will pay.D. Insurers must limit any waiting periods for coverage to 30 days. - correct answer ✔✔A. A requirement to permit adult children to stay on family policies until age 26. A patient is very upset because her insurance denied her claim. She was seen for a routine physical which is not covered by her insurance. The patient asks you to change the diagnosis code in order for the insurance company to pay the claim. Which of the following should be done? A. Explain to the patient the codes are correct and you cannot change the diagnosis unless you have her consent in writing. B. Have the provider or coder review the encounter to see if another diagnosis is appropriate before making any changes to the codes. C. Change the diagnosis so that the insurance company will pay the claim because a service was rendered and should be paid. D. Submit an appeal for the insurance company to reconsider the claim and include a copy of the medical record for the date of service in question. - correct answer ✔✔B. Have the provider or coder review the encounter to see if another diagnosis is appropriate before making any changes to the codes. Which of the following sites of service must adhere to EMTALA? I. Physician office II. Ambulatory surgical center III. Emergency department IV. Intensive care unit - correct answer ✔✔III is correct Under OSHA, an emergency action plan should include: I. Evacuation procedures II. Fire extinguisher locations III. Emergency contacts and contact information
B. Medical supplies C. Office rent D. Utilities - correct answer ✔✔A variable expense is one that can vary based on the volume in a clinic. Physician salary, office rent, and utilities are usually considered fixed expenses that do not vary. Medical supply costs will vary depending on the number of patients that are seen. B. As a manager, you are considering whether to purchase a new diagnostic device. The price of the device is $20,000 which will be paid in equal payments over 4 years. The average revenue you can expect per test is $40. The cost of supplies for each test is $5. Not accounting for staff costs, how many tests would need to be performed each year to break even? - correct answer ✔✔This is found by dividing the yearly cost of the equipment (20,000/4= 5,000) by the profit from each test performed (40-5=35). The result is 5,000 / 35 = 142.9. Therefore, 143 tests would need to be performed to cover the cost of the equipment and break even. Medical practices can operate their financials either under a cash-based accounting system or an accrual-based accounting system. Which of the following is the best advantage for using an accrual-based accounting system? - correct answer ✔✔The accrual method of accounting records revenues when they are earned and expenses when they have been incurred and provides a more accurate reflection of your current financial position. Cash-based accounting is generally simpler because it recognizes revenues only when cash is collected and recognizes expenses only when cash is paid. Cash-based accounting provides a truer reflection of actual cash on hand and requires less reconciliation such as contractual adjustments. B. During a specific month, your practice appears to have consistent productivity and charges submitted. Expenses also appear to be in line and consistent. However, you notice your accounts receivable has increased dramatically over the month. Based on this information, which of the following statements would be accurate?
I. The income on a cash-based income statement should decrease II. The income on an accrual-based income statement would decreaseIII. There should not be a significant difference in beginning and ending cash amounts on your cash flow statement IV. The equity on your balance sheet should remain fairly constant V. The amount of assets on your balance sheet will grow higher than will your liabilities and equity. - correct answer ✔✔If accounts receivable spike during a month, that means fewer payments have been received, which will decrease collections and the income on the income statement. Decreased collections will also negatively impact your cash flow statement which monitors cash levels in your practice. Because accrual based accounting measures income based on charges, it would not be affected. Equity on your balance sheet is not directly affected by a change in cash flow as assets include both cash and accounts receivable. Finally, assets must always equal liabilities and equity on a balance sheet. I and IV are correct As a manager you are preparing to apply for a large bank loan. In so doing, you will need to represent to the bank the overall financial strength of your business including money coming in, money owed to you, and money that you owe to other people. Which financial statement is best used to represent the current status of your practice in this regard? - correct answer ✔✔The balance sheet is a snapshot of a business' financial condition at a specific point in time. It includes values for assets, liabilities, and stockholders' equity. Which code set is used to identify procedures? I. ICD-10-CM Index to Diseases and Injuries (Alphabetic Index) II. ICD-10-CM Tabular List III. ICD-10-PCS IV. HCPCS Level II
B. Ensure medical documentation supports the medical necessity for the services rendered. C. Provide billing staff with the details included in the payer contracts to ensure proper billing. D. Provide medical documentation with an appeal letter to support the services rendered. - correct answer ✔✔D. Provide medical documentation with an appeal letter to support the services rendered. -denial already happened in this scenario Using the policy provided, answer the question below.Facilitating Financial Arrangements1. The financial counselor should memorize the payment methods available to the patients and be prepared to discuss each. Basic methods used include:• Payment in full• Credit cards or a health care credit plan• Three equal payments-prior to services, halfway through and upon completion• Five equal payments-prior to services, during and upon completion2. The financial counselor should open the topic of finances with the patient."Mrs. Smith, has anyone discussed with you the various methods we have available here in the office for taking care of your fee?"3. Use visual aids to improve your patient's understanding. Write down each method of payment as you describe it, or use a pre-printed list of payment methods and check the methods off as you discuss them.4. Suggest sources of financing.• Savings account• Loans• Insurance policies• - correct answer ✔✔C. Explain the payment options and collect the payment in full. Maintaining an appropriate accounts receivable is an important function of a practice manager. Which of the actions below are most effective in reducing an accounts receivable that is aging? I. Review all outstanding balances pending insurance over 30 days. II. Write off all balances over 120 days to minimize old accounts. III. Send out multiple patient statements per month for old balances. IV. Work A/R aging reports by type of payer for greater efficiency.
V. Assign staff aging claims to work based on the adjustment to collection ratio. VI. Review the net collection ratio on a month by month basis. VII. Implement a clear bad debt and third-party collections policy. - correct answer ✔✔B. I, IV, and VII are correct Based on the following productivity dashboard, what valuable information can be derived to use in a conversation with a physician who is upset about decreasing compensation? I. The reason compensation is decreasing is because production levels are below MGMA mean production levels II. The provider's productivity was on track with expectations during the first part of the year but has fallen behind in the latter part of the year. III. Overall the average production of the provider should still support current compensation levels IV. The manager can review trends of the providers practice to identify why there were unexpected drops in production in May - correct answer ✔✔C. II is correct Calculate the days in A/R based on the following numbers over a 2 month ( day) period of time. Total charges = $932,000A/R balance = $616,000Average charge=$225 - correct answer ✔✔To determine the total days in A/R the equation is Total A/R/(Total charges/# of days). For this example:$616,000$932,000/ Answer is 40 Which of the following would NOT be the most effective recruitment tool to select the ideal candidate for an open medical assistant position? A. A detailed job description including the qualifications required to perform the job.B. A proficiency test that includes demonstrating the technical skills required to perform the job.C. Job recruitment ad which generates a high
Which of the following is most important before initiating a marketing campaign to generate new patients for an OB/GYN practice? - correct answer ✔✔A. The practice must have quality controls in place to ensure quality care and patient satisfaction The physician you work for recently attended a medical conference. In talking with other physicians, he learned he could increase his revenue by offering ancillary services in the office instead of referring these services out. You are tasked with determining if this will be profitable. Which of the following is NOT a factor to consider? A. Determine the number of services currently being referred out. B. Determine the number of tests that must be performed to be profitable. C. Determine revenue streams based on Medicare payment amounts provided by the vendor. D. Determine the cost of the equipment and supplies needed to render the ancillary services. - correct answer ✔✔C. Determine revenue streams based on Medicare payment amounts provided by the vendor. Which model of patient scheduling best prevents patients from arriving late and affecting the schedule? - correct answer ✔✔Block scheduling is a model where several patients may be scheduled for a block of time and patients are seen in the order they arrive. This model attempts to mitigate patients showing up late and disrupting the remainder of the appointment times. For example, if the provider can perform three established patient visits every 30 minutes, give three patients the same block of time with the instructions they will be seen in the order they arrive. When planning patient exam rooms, remember - correct answer ✔✔C. The exam table should be positioned to maximize patient privacy while the exam door is open.
What is the most effective way to determine the overall work flow for a practice? - correct answer ✔✔A. Develop a flow chart for each policy and procedure in the practice. Which of the following disclosures of PHI are acceptable without a written release from the patient? - correct answer ✔✔B. Release of a patient's surgical pathology report to an oncologist who will take over the patient's care. Which of the following is not a covered entity under HIPAA? A. Clearinghouse B. Hospital C. Collection agencies D. Diagnostic centers - correct answer ✔✔C. Collection agencies What must a business associate (BA) agreement include? - correct answer ✔✔The business associate must agree to document disclosures of PHI required for covered entities to respond to a request by an individual for an accounting of disclosures of PHI. Once a BA is signed, a confidentially agreement is no longer required because all disclosures are covered by the BA. The covered entity must be given access if requested but there is no requirement it must be online. There are fees for providing services as a BA but not for confidentially. The fees charged for services appear in a contract not the BAA. C. The BA must document all disclosures of PHI to provide to the covered entity upon request. What is the most secure method to allow remote employees access to the EMR? - correct answer ✔✔A. VPN
D. What information should be scanned versus abstracted from the old paper chart? - correct answer ✔✔D. What information should be scanned versus abstracted from the old paper chart? Which statement is TRUE regarding Alternative Payment Models (APMs)? A. Participation in an APM excludes a provider from the Quality Payment Program (QPP). B. An APM is a risk-bearing contract for insurance carriers contracted with CMS. C. A provider can only participate in an APM as a solo practitioner. D. An APM is a fee-for-service contract paid based on quality outcome. - correct answer ✔✔Qualified APMs are risk-bearing contracts that require providers to put up more than "nominal financial risk — for example, through shared losses." D. An APM is a fee-for-service contract paid based on quality outcome. Advances in technology in the medical practice have increased efficiencies in many areas. Which of the following is LEAST impacted in increasing efficiencies? A. Patient response to care B. Real-time claim adjudication C. Electronic payment posting D. Claim editing prior to submission - correct answer ✔✔A. Patient response to care Which statement is NOT true regarding the development of a post disaster check list? A. Make sure the staff knows where all the exits are located. B. Take an inventory of all damaged equipment and supplies.
C. Identify an alternate office location if the office cannot be used. D. Contact patients to inform them. - correct answer ✔✔A. Make sure the staff knows where all the exits are located. As the practice manager, it is your responsibility to minimize risk. To accomplish this, you perform a risk analysis. During the analysis you find that the refrigerator where medications are stored is not cooling to the appropriate temperature. Which of the following is NOT a step in performing a risk analysis? A. Determine the likelihood the risk will cause an adverse effect. B. Quickly resolve all risks identified. C. Determine the financial impact if the risk is not resolved. D. Determine the level of risk to the practice. - correct answer ✔✔B. Quickly resolve all risks identified.
