CPPM Exam Prep – Comprehensive Study Guide (Certification in Physician
Practice Management)
Revenue Per Visit (RPV) - correct answer ✔✔Total amount collected divides by the total number
of patient visits
Advance Benefit Notification (ABN) - correct answer ✔✔Notification given to patients advising
Medicare may not cover a certain procedure or service
Payment for fee for service is based on - correct answer ✔✔CPT & HCPCS Level II
MCO - correct answer ✔✔Private Health Plan
Place of Service (POS) determines correct reimbursement when - correct answer ✔✔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 - correct answer ✔✔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? - correct answer ✔✔Front Desk
What can result in claim denial? - correct answer ✔✔Incorrect POS, incorrect NPI, and a
truncated diagnosis code
Patients are prepared to make payments at the time of there visits when? - correct answer
✔✔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? - correct answer ✔✔Medical necessity
What code set represents healthcare equipment, drugs and supplies? - correct answer ✔✔ICD-
10.PCS
ICD-10-CM - correct answer ✔✔International Classification of Diseases, Tenth Revision, Clinical
Modification CM codes represent the diagnosis/reason a service is performed.
ICD-10-PCS - correct answer ✔✔International Classification of Diseases, Revision Procedural
Coding System. These represent procedures performed at inpatient hospital facilities
CPT codes - correct answer ✔✔current procedural terminology represent procedures
performed & bilked by physicians and non-physicians practitioners (APP's)
HCPCS Level II - correct answer ✔✔for products and supplies and services not included in level
I. the code is alphanumeric
Clean Claim Form - correct answer ✔✔A form that is complete and accurate and includes all
provider information and other additional information to process for payment
History of present illness - correct answer ✔✔Chronological description of the development of
patients complaint
Which codes are used by physicians and APP's to report professional services? - correct answer
✔✔CPT & HCPCS Level Ii
Procedure codes are reported using which codes? - correct answer ✔✔CPT
Practice Management)
Revenue Per Visit (RPV) - correct answer ✔✔Total amount collected divides by the total number
of patient visits
Advance Benefit Notification (ABN) - correct answer ✔✔Notification given to patients advising
Medicare may not cover a certain procedure or service
Payment for fee for service is based on - correct answer ✔✔CPT & HCPCS Level II
MCO - correct answer ✔✔Private Health Plan
Place of Service (POS) determines correct reimbursement when - correct answer ✔✔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 - correct answer ✔✔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? - correct answer ✔✔Front Desk
What can result in claim denial? - correct answer ✔✔Incorrect POS, incorrect NPI, and a
truncated diagnosis code
Patients are prepared to make payments at the time of there visits when? - correct answer
✔✔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? - correct answer ✔✔Medical necessity
What code set represents healthcare equipment, drugs and supplies? - correct answer ✔✔ICD-
10.PCS
ICD-10-CM - correct answer ✔✔International Classification of Diseases, Tenth Revision, Clinical
Modification CM codes represent the diagnosis/reason a service is performed.
ICD-10-PCS - correct answer ✔✔International Classification of Diseases, Revision Procedural
Coding System. These represent procedures performed at inpatient hospital facilities
CPT codes - correct answer ✔✔current procedural terminology represent procedures
performed & bilked by physicians and non-physicians practitioners (APP's)
HCPCS Level II - correct answer ✔✔for products and supplies and services not included in level
I. the code is alphanumeric
Clean Claim Form - correct answer ✔✔A form that is complete and accurate and includes all
provider information and other additional information to process for payment
History of present illness - correct answer ✔✔Chronological description of the development of
patients complaint
Which codes are used by physicians and APP's to report professional services? - correct answer
✔✔CPT & HCPCS Level Ii
Procedure codes are reported using which codes? - correct answer ✔✔CPT
