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Practice for CPPM Exam – Certified Physician Practice
Manager (comprehensive practice questions and study
guide)
*Efficiency - correct answer ✔✔Process & doing things right *Effectiveness - correct answer ✔✔Outcomes & doing the right thing Accrual Accounting - correct answer ✔✔Records revenues when they are earned & expenses when they have been accrued. Provides a more accurate reflection of your current financial situation Cash Based Accounting - correct answer ✔✔Recognizes revenue only when cash is collected & expenses when cash is paid. Provides a truer reflection of actual cash on hand & requires less reconciliation Chart of Accounts - correct answer ✔✔Lists all potential accounts for all financial information (income, expenses, assets, liabilities, equities Income Statement - correct answer ✔✔Records all revenues & expenses associated with the business for a specified time. Summary of a company's profit or loss during a given period Balance Sheet - correct answer ✔✔Snapshot of buisness' financial condition at specific time. Includes values for assets, liabilities & stockholders equity Cash Flow Statement - correct answer ✔✔Financial statement used to maintain awareness of funds (cash available) to support ongoing business operations
Break Even Point - correct answer ✔✔Point where revenues for services minus all variable expenses = the fixed expenses & add'l revenue will start creating a profit for the business OSHA - correct answer ✔✔*Procedures for reporting a file
- Evacuatin procedures during emergency *fire extinguisher locations
- Emergency contacts & info
- Designated meeting location
- Staff assignments & responses **Revenue Per Visit (RPV) Calculated - correct answer ✔✔Review payor contracts = Toal amount collected ./. total # pt visits **Days in A/R formula - correct answer ✔✔total A/R ./. (total charges ./. total days in A/R (i.e. $558039 ./. ($700,00 ./. 60) Medical Necessity - correct answer ✔✔Most important criteria for E&M Days in A/R - correct answer ✔✔How long it takes to collect a charge. Good is less than 40 days **Days in A/R forumula - correct answer ✔✔Total A/R ./. Total charges ./. # of days for charges Assests = - correct answer ✔✔liabilities & equity
HCPCS Level II CPT CPT & HCPCS Dates - correct answer ✔✔1/ ICD 9 Dates - correct answer ✔✔10/ Bad Debt Ratio - correct answer ✔✔bad debt right offs are adjustments that will result in no collections Bad Debt Ratio - correct answer ✔✔Total bad debt for period ./. total charges for period State Prompt Payment Laws - correct answer ✔✔If payments are late by insurance companies The following will NOT prevent claim denials - correct answer ✔✔Provide medical documentation with an appeal letter to support the service rendered Productivity Report - correct answer ✔✔Details the volume of procedures being performed by each provider Denials Report & Denials Rate - correct answer ✔✔Important to cash flow - use weekly to identify denials. Should always stay below 5% Denials Report & Denials Rate Formula - correct answer ✔✔Total # of denials ./. tot claims submitted
Adjustments to collection - correct answer ✔✔Used for monitoring fluctuations in adjustments **Adjustment to Collections Ratio Formula - correct answer ✔✔Tot adjustments for period ./. Tot collections for period Net Collection Rate - correct answer ✔✔Determines how well a business is collecting on eligible revenue. Better to look at net collection rates over a 3- 6-9-12 mo period of time Net Collection Rate Formula - correct answer ✔✔Tot Receipts - Refunds ./. Tot Charges - Contractual Adj A/R Aging Summary - correct answer ✔✔Used to identify the aging of receivables & if accounts are being collected in a timely manner **PQRS - correct answer ✔✔Physicain Quality Reporting System = eligible providers are all health care providers, but not out pt surgery center or labs **PPACA - correct answer ✔✔Pt Protection & Affordable Act = allows sharing of IRS data to identfiy fraudulent providers with tax debts VOB - correct answer ✔✔Verification of Benefits ROI - correct answer ✔✔Return on Investment PECOS - correct answer ✔✔Provider Enrollment, Chain & Ownership System Medicare EHHR Incentive Program - correct answer ✔✔does NOT include NPs, but does include drs of MD, podiatrists, dentists, psychiatrists
HIPPA - correct answer ✔✔applies to providers, health plans, clearinghouses, anyone who submits any health info in an electronic manner Business Associates Agreement - correct answer ✔✔needed when any entity is sharing PHI. NOT used for employees. Also, NOT used for janitors, building maintenance or tax accountants HIPPA Breech of PHI of 45 records - correct answer ✔✔requires pt notification within 60 days of breech Offsite biller - correct answer ✔✔Required to log on to remote server that has automatic logoff feature set Subpoena for medical records - correct answer ✔✔You can send records requested by court order without authorization from pt Employment Questions OK to ask - correct answer ✔✔worked under different name ever convicted of crime if U.S. citizen education level including degrees & certifications If relatives employed by organizations prior employment Employment Questions NOT ok to ask - correct answer ✔✔age, race, sex, religion, national origin, disability, pregnancy 401K - correct answer ✔✔Employer & employee BOTH contribute
HR forms kept in separate file from employee's personnel file & in locked location - correct answer ✔✔OSHA compliance completed FMLA form Employment eligibilty forms (INSS form 1-9) Worker's compenstation disability forms **Income Statement Model - correct answer ✔✔this physician compensation model requires allocation of revenue & expenses to each physicain in the practice Mid Levels - correct answer ✔✔Need Standard of Care agreement if only billing incident to **SWOT Analysis - correct answer ✔✔Strengths, Weaknesses, Opportunities, Threats **Anti-Kickback Law - correct answer ✔✔can't solicit or receive payment for pt referrals **Compliance Plan - correct answer ✔✔Includes: designate compliance officer training & education Written policies for denial mgmt software Internal auditing **Stark Law - correct answer ✔✔Prohibits physicians from referring pts to medical facilities in which the physician or member of immediate family has a financial interest
QA = Quality Assurance - correct answer ✔✔Internal audit of billing procedures to verify compliance with fed & state regulations QC = Quality Control - correct answer ✔✔a system of technical activities that measures against a criteria or standard (i.e. lab equipment calibrations) *Plan-Do-Check-Act - correct answer ✔✔A quality cycle & QI method that systematically impacts a process or system Insurance Reform - correct answer ✔✔ 1/1/15 - pymt reduction for MDs with no EHR
- Medical cost ratio = 85%
- Adult children til age 26 on family policies
- Must provide preventive health
- No annual or lifetime maxiums
- Can't cancel coverage when beneficiary gets sick
- no prior auth for ER
- restriction on out of pocket maximum, copay & deductibles
- no pre-existing conditions
- 5% increase in mental health services
- employers with 50+ employees are fined for not offering coverage
- employers with <25 ill be offered subsidies S Corp - correct answer ✔✔limits the # of shareholders, not taxed twice, profit can flow thru to partners equally Business Relationships - correct answer ✔✔bankers, accountants, attorneys, investment adviosrs
C Corp - correct answer ✔✔most formal; offers stock with or without voting rights & have unlimited shareholder. Provides ownership of business to physicians as they join the practice, but are taxed twice, 1st at the corporate level, then again at the physicain level
