Practice for CPPM Exam Questions and Answers 100% Pass

Practice for CPPM Exam Questions and Answers 100% Pass *Efficiency Process & doing things right *Effectiveness Outcomes & doing the right thing Accural Accounting Records revenues when they are earned & expenses when they have been accrued. Provides a more accurate reflection of your current financial situation Cash Based Accounting Recognizes revenue only when cash is collected & expenses when cash is paid. Provides a truer reflection of actual cash on hand & requires less reconciliation Chart of Accounts Lists all potential accounts for all financial information (income, expenses, assets, liabilities, equities Income Statement Records all revenues & expenses associated with the business for a specified time. Summary of a company's profit or loss during a given period Balance Sheet Snapshot of buisness' financial condition at specific time. Includes values for assets, liabilities & stockholders equity Cash Flow Statement Financial statement used to maintain awareness of funds (cash available) to support ongoing business operations Break Even Point Point where revenues for services minus all variable expenses = the fixed expenses & add'l revenue will start creating a profit for the business OSHA *Procedures for reporting a file * Evacuatin procedures during emergency *fire extinguisher locations * Emergency contacts & info * Designated meeting location * Staff assignments & responses **Revenue Per Visit (RPV) Calculated Review payor contracts = Toal amount collected ./. total # pt visits **Days in A/R formula total A/R ./. (total charges ./. total days in A/R (i.e. $558039 ./. ($700,00 ./. 60) Medical Necessity Most important criteria for E&M Days in A/R How long it takes to collect a charge. Good is less than 40 days **Days in A/R forumula Total A/R ./. Total charges ./. # of days for charges Assests = liabilities & equity Assests If assests are higher than liabilites, that's a good thing **Net Collection Rate Total Receipts - Refunds ./. Total Charges - Contractual Adj Bad Deb Ratios Total bad debt for period ./. total charges for period Denials Report & Denials Rate Total # of denials ./. total claims submitted *LLC Limited Liaiblity Company - unlimited owners & limit the am't of taxes *Disaster Recovery Planning Should include prevention, detection & correction *Pod Has nurses, exam rooms & physicians offices all located in the same area *Quantitative Risk Analaysis Measure of the probabilities of variouus adverse events & the likely extent of the losses if a particular event occurs EHR Date 1/1/2015 - Providers who have NOT implemented EHR will begin to see a reduction in Medicare payment Procedure Code Sets ICD 9 CM Volume II (hospital input charges HCPCS Level II CPT CPT & HCPCS Dates 1/1 ICD 9 Dates 10/1 Bad Debt Ratio bad debt right offs are adjustments that will result in no collections Bad Debt Ratio Total bad debt for period ./. total charges for period State Prompt Payment Laws If payments are late by insurance companies The following will NOT prevent claim denials Provide medical documentation with an appeal letter to support the service rendered Productivity Report Details the volume of procedures being performed by each provider Denials Report & Denials Rate Important to cash flow - use weekly to identify denials. Should always stay below 5% Denials Report & Denials Rate Formula Total # of denials ./. tot claims submitted Adjustments to collection Used for monitoring fluctuations in adjustments **Adjustment to Collections Ratio Formula Tot adjustments for period ./. Tot collections for period Net Collection Rate Determines how well a business is collecting on eligible revenue. Better to look at net collection rates over a 3-6-9-12 mo period of time Net Collection Rate Formula Tot Receipts - Refunds ./. Tot Charges - Contractual Adj A/R Aging Summary Used to identify the aging of receivables & if accounts are being collected in a timely manner **PQRS Physicain Quality Reporting System = eligible providers are all health care providers, but not out pt surgery center or labs **PPACA Pt Protection & Affordable Act = allows sharing of IRS data to identfiy fraudulent providers with tax debts VOB Verification of Benefits ROI Return on Investment PECOS Provider Enrollment, Chain & Ownership System Medicare EHHR Incentive Program does NOT include NPs, but does include drs of MD, podiatrists, dentists, psychiatrists VPN Virtual Private Network = extremely secure connections between private networks tunneled through the internet False Claims Act & Qui Tam Whistle Bloer Act - prohibits any person from knowingly presenting or causing false claims Rule by All all physician partners are involved in decision making **Profit Share Plan contributions only by the employer; if offered to employer, must be offered to employee FMLA Family Medical Leave Act = only applies to employer groups with 50 or more employees & gives up to 12 wks unpaid leave & holds the job **EDI = Electronic Data Interchange Current version for HIPPA transactions is X12 Version 5010, NCPDP Version D.0 HIPPA Breach - under 500 pts report once yearly HIPPA Breech - over 500 pts but at least 12 pt addresses out of date, publish a print ad of the breech in nespaper & include the date of the breech & when it was discovered; a brief description of incident ; descriptioin of unsecured PHI involved & suggested steps for individuals to take to protect against problems HIPPA breech - over 500 pts must notify local media & notify Secretary of HHS HIPPA applies to providers, health plans, clearinghouses, anyone who submits any health info in an electronic manner Business Associates Agreement needed when any entity is sharing PHI. NOT used for employees. Also, NOT used for janitors, building maintenance or tax accountants HIPPA Breech of PHI of 45 records requires pt notification within 60 days of breech Offsite biller Required to log on to remote server that has automatic logoff feature set Subpoena for medical records You can send records requested by court order without authorization from pt Employment Questions OK to ask worked under different name ever convicted of crime if U.S. citizen education level including degrees & certifications If relatives employed by organizations prior employment Employment Questions NOT ok to ask age, race, sex, religion, national origin, disability, pregnancy 401K Employer & employee BOTH contribute HR forms kept in separate file from employee's personnel file & in locked location OSHA compliance completed FMLA form Employment eligibilty forms (INSS form 1-9) Worker's compenstation disability forms **Income Statement Model this physician compensation model requires allocation of revenue & expenses to each physicain in the practice Mid Levels Need Standard of Care agreement if only billing incident to **SWOT Analysis Strengths, Weaknesses, Opportunities, Threats **Anti-Kickback Law can't solicit or receive payment for pt referrals **Compliance Plan Includes: designate compliance officer training & education Written policies for denial mgmt software Internal auditing **Stark Law Prohibits physicians from referring pts to medical facilities in which the physician or member of immediate family has a financial interest **Stark Law Exceptions preventive screeing tests, immunications & vaccines **OSHA Bloodborne pathogens Occupationsal exposure determination Use of universal precatuions Use of engineering & work practice controls Use of personal protective equipment Vaccincation policy for Hep B Evaluation for use of safer needles & sharps Post exposure evaluation & follow up Containment of regulated aste Communication of hazards to employees OSHA - types that must be reported Death missed days from work restricted work or job transfer medical treatment beyond first aid loss of consciousness You're buying aCT scan. What laws to consider? Stark & AntiKickback **OIG published resource for AntiKickback Laws Fraud Alert QI = Quality Improvement Routine measurement of performance; QI fixes processes, not people QA = Quality Assurance Internal audit of billing procedures to verify compliance with fed & state regulations QC = Quality Control a system of technical activities that measures against a criteria or standard (i.e. lab equipment calibrations) **Plan-Do-Check-Act A quality cycle & QI method that systematically impacts a process or system Insurance Reform * 1/1/15 - pymt reduction for MDs with no EHR * Medical cost ratio = 85% * Adult children til age 26 on family policies * Must provide preventive health * No annual or lifetime maxiums * Can't cancel coverage when beneficiary gets sick * no prior auth for ER * restriction on out of pocket maximum, copay & deductibles * no pre-existing conditions * 5% increase in mental health services * employers with 50+ employees are fined for not offering coverage * employers with 25 ill be offered subsidies S Corp limits the # of shareholders, not taxed twice, profit can flow thru to partners equally Business Relationships bankers, accountants, attorneys, investment adviosrs C Corp most formal; offers stock with or without voting rights & have unlimited shareholder. Provides ownership of business to physicians as they join the practice, but are taxed twice, 1st at the corporate level, then again at the physicain level