CPPM COMPLETE QUESTIONS AND
ANSWERS GRADED A+
◉ Denials report & Denials Rate
Answer: Important to cash flow - use weekly to identify denials.
Should always stay below 5%
◉ Adjustments to collection
Answer: Total # of denials ./. total claims submitted
◉ **Adjustment to Collections Ratio Formula
Answer: Total adjustments for period ./. Total collections for
period
◉ Net Collection Rate
Answer: Determines how well a business is collection on eligible
revenue. Better to look at net
◉ A/R Aging Summary
Answer: Used to identify the aging of receivables & if accounts are
being collected in a timely manner.
◉ PQRS
,Answer: Physician Quality Reporting System - eligible providers
are all health care providers, but not out pt surgery center or labs
◉ PPACA
Answer: Patient Protection & Affordable Care Act - allows sharing
of IRS data to identify fraudulent providers with tax debts.
◉ VOB
Answer: Verification of Benefits
◉ ROI
Answer: Return on Investment
◉ PECOS
Answer: Provider Enrollment Chain Ownership System
◉ Medicare EHHR Incentive Program
Answer: Does Not include NP's, but does include Dr's of MD,
podiatrists, denitists, psychiatrists
◉ VPN
Answer: Virtual Private Network - extremely secure connections
between private networks tunneled through the internet.
,◉ False Claims Act & Qui Tam
Answer: Whistle Blower Act - prohibits any person from
knowingly presenting or causing false claims
◉ Rule by All
Answer: all physician partners are involved in decision making
◉ Profit Share Plan
Answer: contributions only by employer; if offered to employer,
must be offered to employee
◉ FMLA
Answer: Family Medical Leave Act - only applies to employer
groups with 50 or more employees & gives up to 12 weeks unpaid
leave and holds the job.
◉ EDI Electronic Data Interchange
Answer: Curretn version for HIPPA transactions is X12 Version
5010, NCPDP Version D.0
◉ HIPPA Breach under 500 patients
Answer: Reports once yearly
◉ HIPPA Breach over 500 patients
, Answer: but at least 12 patients addresses out of date, publish a
print ad of the breach in newspaper & include the date of the
breach, when it was discovered, a brief description of the incident,
description of unsecured PHI involved and suggested steps for the
individual to take to protect against problems.
◉ HIPPA Breach over 500 patients*
Answer: must notify local media and notify Secretary of HHS
◉ HIPPA
Answer: applies to providers, health plans, clearinghouses,
anyone who submits any health information in an electronic
manner.
◉ Business Associates Agreement
Answer: needed when an entity is sharing PHI. NOt used for
employees, Also Not used for janitors, building maintenance or tax
accountants.
◉ HIPPA Breach of PHI of 45 records
Answer: requires patient notification within 60 days of the breech
◉ Offsite biller
Answer: Required to log on to remote server that has automatic
logoff feature set.
ANSWERS GRADED A+
◉ Denials report & Denials Rate
Answer: Important to cash flow - use weekly to identify denials.
Should always stay below 5%
◉ Adjustments to collection
Answer: Total # of denials ./. total claims submitted
◉ **Adjustment to Collections Ratio Formula
Answer: Total adjustments for period ./. Total collections for
period
◉ Net Collection Rate
Answer: Determines how well a business is collection on eligible
revenue. Better to look at net
◉ A/R Aging Summary
Answer: Used to identify the aging of receivables & if accounts are
being collected in a timely manner.
◉ PQRS
,Answer: Physician Quality Reporting System - eligible providers
are all health care providers, but not out pt surgery center or labs
◉ PPACA
Answer: Patient Protection & Affordable Care Act - allows sharing
of IRS data to identify fraudulent providers with tax debts.
◉ VOB
Answer: Verification of Benefits
◉ ROI
Answer: Return on Investment
◉ PECOS
Answer: Provider Enrollment Chain Ownership System
◉ Medicare EHHR Incentive Program
Answer: Does Not include NP's, but does include Dr's of MD,
podiatrists, denitists, psychiatrists
◉ VPN
Answer: Virtual Private Network - extremely secure connections
between private networks tunneled through the internet.
,◉ False Claims Act & Qui Tam
Answer: Whistle Blower Act - prohibits any person from
knowingly presenting or causing false claims
◉ Rule by All
Answer: all physician partners are involved in decision making
◉ Profit Share Plan
Answer: contributions only by employer; if offered to employer,
must be offered to employee
◉ FMLA
Answer: Family Medical Leave Act - only applies to employer
groups with 50 or more employees & gives up to 12 weeks unpaid
leave and holds the job.
◉ EDI Electronic Data Interchange
Answer: Curretn version for HIPPA transactions is X12 Version
5010, NCPDP Version D.0
◉ HIPPA Breach under 500 patients
Answer: Reports once yearly
◉ HIPPA Breach over 500 patients
, Answer: but at least 12 patients addresses out of date, publish a
print ad of the breach in newspaper & include the date of the
breach, when it was discovered, a brief description of the incident,
description of unsecured PHI involved and suggested steps for the
individual to take to protect against problems.
◉ HIPPA Breach over 500 patients*
Answer: must notify local media and notify Secretary of HHS
◉ HIPPA
Answer: applies to providers, health plans, clearinghouses,
anyone who submits any health information in an electronic
manner.
◉ Business Associates Agreement
Answer: needed when an entity is sharing PHI. NOt used for
employees, Also Not used for janitors, building maintenance or tax
accountants.
◉ HIPPA Breach of PHI of 45 records
Answer: requires patient notification within 60 days of the breech
◉ Offsite biller
Answer: Required to log on to remote server that has automatic
logoff feature set.
