CPPM Exam Prep Questions and Answers Rated A
Total amount collected divides by the total number of
Revenue Per Visit (RPV)
patient visits
Notification given to patients advising Medicare may not
Advance Benefit Notification (ABN)
cover a certain procedure or service
Payment for fee for service is based on CPT & HCPCS Level II
MCO Private Health Plan
The professional component for services provided in a fa-
cility (I.e. HOD) are less than when provided in a physician
Place of Service (POS) determines correct reimbursement
oflce as the physician doesn't have any practice expense
when
at the facility. (In private practice they pay rent, statt etc
whereas is HOD these are paid by the facility)
DEA number Is not needed for the online application to CMS for an NPI
Customer service, optimizing physician time and claim
Front Desk
quality assurance are key components to which role?
Incorrect POS, incorrect NPI, and a truncated diagnosis
What can result in claim denial?
code
Patients are prepared to make payments at the time of Payment & collection policies are prominently posted in
there visits when? the oflce
What is the most important criteria to meet for the selec-
Medical necessity
tion of Evaluation and Management (E/M) codes?
What code set represents healthcare equipment, drugs
ICD-10.PCS
and supplies?
International Classification of Diseases, Tenth Revision,
ICD-10-CM Clinical Modification CM codes represent the diagno-
sis/reason a service is performed.
International Classification of Diseases, Revision Proce-
ICD-10-PCS dural Coding System. These represent procedures per-
formed at inpatient hospital facilities
1/9
, CPPM Exam Prep Questions and Answers Rated A
current procedural terminology represent procedures
CPT codes performed & bilked by physicians and non-physicians
practitioners (APP's)
for products and supplies and services not included in
HCPCS Level II
level I. the code is alphanumeric
A form that is complete and accurate and includes all
Clean Claim Form provider information and other additional information to
process for payment
Chronological description of the development of patients
History of present illness
complaint
Which codes are used by physicians and APP's to report
CPT & HCPCS Level Ii
professional services?
Procedure codes are reported using which codes? CPT
Medicare patient with Parts A, B & C and no fault auto in-
surance is seen in the ED following a minor auto accident, Auto No-Fault
who is the primary insurance?
What is the first thing to review when a private payer
Payer Contract to see if denial is appropriate
repeatedly denies a specific code (o.e. Venipuncture)?
Codes based on complete and accurate medical record
Vital component of medical coding
documentation in the patients chart
How often should you run a productivity report? Twice a year, minimally
What is one purpose for a productivity report? To verify a good payer mix for a strong revenue stream
Numerous clinical & administrative approval require-
What can add to an ineflcient bad debt management
ments, unclear policies on write-ott thresholds, and un-
process?
clear policies that limit the amount of balance billing
A prospective method of payment. Payments are based on
Capitation payment
a physician fee schedules negotiated with the payer.
2/9
Total amount collected divides by the total number of
Revenue Per Visit (RPV)
patient visits
Notification given to patients advising Medicare may not
Advance Benefit Notification (ABN)
cover a certain procedure or service
Payment for fee for service is based on CPT & HCPCS Level II
MCO Private Health Plan
The professional component for services provided in a fa-
cility (I.e. HOD) are less than when provided in a physician
Place of Service (POS) determines correct reimbursement
oflce as the physician doesn't have any practice expense
when
at the facility. (In private practice they pay rent, statt etc
whereas is HOD these are paid by the facility)
DEA number Is not needed for the online application to CMS for an NPI
Customer service, optimizing physician time and claim
Front Desk
quality assurance are key components to which role?
Incorrect POS, incorrect NPI, and a truncated diagnosis
What can result in claim denial?
code
Patients are prepared to make payments at the time of Payment & collection policies are prominently posted in
there visits when? the oflce
What is the most important criteria to meet for the selec-
Medical necessity
tion of Evaluation and Management (E/M) codes?
What code set represents healthcare equipment, drugs
ICD-10.PCS
and supplies?
International Classification of Diseases, Tenth Revision,
ICD-10-CM Clinical Modification CM codes represent the diagno-
sis/reason a service is performed.
International Classification of Diseases, Revision Proce-
ICD-10-PCS dural Coding System. These represent procedures per-
formed at inpatient hospital facilities
1/9
, CPPM Exam Prep Questions and Answers Rated A
current procedural terminology represent procedures
CPT codes performed & bilked by physicians and non-physicians
practitioners (APP's)
for products and supplies and services not included in
HCPCS Level II
level I. the code is alphanumeric
A form that is complete and accurate and includes all
Clean Claim Form provider information and other additional information to
process for payment
Chronological description of the development of patients
History of present illness
complaint
Which codes are used by physicians and APP's to report
CPT & HCPCS Level Ii
professional services?
Procedure codes are reported using which codes? CPT
Medicare patient with Parts A, B & C and no fault auto in-
surance is seen in the ED following a minor auto accident, Auto No-Fault
who is the primary insurance?
What is the first thing to review when a private payer
Payer Contract to see if denial is appropriate
repeatedly denies a specific code (o.e. Venipuncture)?
Codes based on complete and accurate medical record
Vital component of medical coding
documentation in the patients chart
How often should you run a productivity report? Twice a year, minimally
What is one purpose for a productivity report? To verify a good payer mix for a strong revenue stream
Numerous clinical & administrative approval require-
What can add to an ineflcient bad debt management
ments, unclear policies on write-ott thresholds, and un-
process?
clear policies that limit the amount of balance billing
A prospective method of payment. Payments are based on
Capitation payment
a physician fee schedules negotiated with the payer.
2/9
