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