CPPM Exam Prep Questions and Answers

CPPM Exam Prep Questions and Answers Revenue Per Visit (RPV) - Answer️️ -Total amount collected divides by the total number of patient visits Advance Benefit Notification (ABN) - Answer️️ -Notification given to patients advising Medicare may not cover a certain procedure or service Payment for fee for service is based on - Answer️️ -CPT & HCPCS Level II MCO - Answer️️ -Private Health Plan Place of Service (POS) determines correct reimbursement when - Answer️️ -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 - Answer️️ -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? - Answer️️ -Front Desk What can result in claim denial? - Answer️️ -Incorrect POS, incorrect NPI, and a truncated diagnosis code Patients are prepared to make payments at the time of there visits when? - Answer️️ - 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? - Answer️️ -Medical necessity What code set represents healthcare equipment, drugs and supplies? - Answer️️ - ICD-10.PCS ICD-10-CM - Answer️️ -International Classification of Diseases, Tenth Revision, Clinical Modification CM codes represent the diagnosis/reason a service is performed. ICD-10-PCS - Answer️️ -International Classification of Diseases, Revision Procedural Coding System. These represent procedures performed at inpatient hospital facilities CPT codes - Answer️️ -current procedural terminology represent procedures performed & bilked by physicians and non-physicians practitioners (APP's) HCPCS Level II - Answer️️ -for products and supplies and services not included in level I. the code is alphanumeric Clean Claim Form - Answer️️ -A form that is complete and accurate and includes all provider information and other additional information to process for payment History of present illness - Answer️️ -Chronological description of the development of patients complaint Which codes are used by physicians and APP's to report professional services? - Answer️️ -CPT & HCPCS Level Ii Procedure codes are reported using which codes? - Answer️️ -CPT Medicare patient with Parts A, B & C and no fault auto insurance is seen in the ED following a minor auto accident, who is the primary insurance? - Answer️️ -Auto No- Fault What is the first thing to review when a private payer repeatedly denies a specific code (o.e. Venipuncture)? - Answer️️ -Payer Contract to see if denial is appropriate Vital component of medical coding - Answer️️ -Codes based on complete and accurate medical record documentation in the patients chart How often should you run a productivity report? - Answer️️ -Twice a year, minimally What is one purpose for a productivity report? - Answer️️ -To verify a good payer mix for a strong revenue stream What can add to an inefficient bad debt management process? - Answer️️ -Numerous clinical & administrative approval requirements, unclear policies on write-off thresholds, and unclear policies that limit the amount of balance billing Capitation payment - Answer️️ -A prospective method of payment. Payments are based on a physician fee schedules negotiated with the payer. What accounts should be considered for collection? - Answer️️ -90+ days with a balance greater than $10 What should you consider when conducting a registration audit? - Answer️️ -Address, phone #, employer, insurance verification, and co-pay collected Three indicators for monitoring receivables - Answer️️ -Net collection rate, denials, and A/R days Three components to having claims paid by payer - Answer️️ -Procedure code, diagnosis code(s), and insurance policy number What payments should be collected by the front desk - Answer️️ -Any ba