CPPM Exam Prep Verified Answers

CPPM Exam Prep Verified Answers Revenue and Billing What is Revenue Per Visit (RPV)? Options: a. The total amount collected divided by the total number of patient visits; b. A type of insurance plan Answer: a. The total amount collected divided by the total number of patient visits What is Advance Benefit Notification (ABN)? Options: a. A notification given to patients advising Medicare may not cover a certain procedure or service; b. A type of insurance plan Answer: a. A notification given to patients advising Medicare may not cover a certain procedure or service Coding and Reimbursement What codes are used to report professional services? Options: a. CPT and HCPCS Level I; b. ICD-10-PCS and CPT Answer: a. CPT and HCPCS Level II What determines correct reimbursement when providing services in a facility? Options: a. The POS determines correct reimbursement; b. The CPT code determines correct reimbursement Answer: a. The POS determines correct reimbursement Front Desk Operations What are key components of the Front Desk role? Options: a. Customer service, optimizing physician time, and claim quality assurance; b. Claim processing, patient scheduling, and billing Answer: a. Customer service, optimizing physician time, and claim quality assurance Coding Guidelines What can result in claim denial? Options: a. Incorrect POS, incorrect NPI, and truncated diagnosis code; b. Incorrect CPT code, incorrect ICD-10 code, and missing information Answer: a. Incorrect POS, incorrect NPI, and truncated diagnosis code Medical Records What is the most important criterion to meet for E/M code selection? Options: a. Medical necessity; b. Patient's age Answer: a. Medical necessity What is one purpose for a productivity report? ️To verify a good payer mix for a strong revenue stream What can add to an inefficient bad debt management process? ️Numerous clinical & administrative approval requirements, unclear policies on write-off thresholds, and unclear policies that limit the amount of balance billing Capitation payment ️A prospective method of payment. Payments are based on a physician fee schedules negotiated with the payer. What accounts should be considered for collection? ️90+ days with a balance greater than $10 What should you consider when conducting a registration audit? ️Address, phone #, employer, insurance verification, and co-pay collected Three indicators for monitoring receivables ️Net collection rate, denials, and A/R days Three components to having claims paid by payer ️Procedure code, diagnosis code(s), and insurance policy number What payments should be collected by the front desk ️Any balance due that is the patients responsibility Which denials should be a priority? ️Inclusive service as this is typically the highest dollar amount. To verify the validity, check the payers bundling edits and payer contracts. What report and/or measurement identifies how well a practice collects on allowable charges ️ Common performance indicators for charge entry includes ️Days to enter charges, missing charges, coding accuracy Prospective Fee Schedule ️The type of reimbursement used by payers to pay a predetermined set amount for each procedure code What tools should be considered when developing a budget? ️Balance sheet, chart of accounts and expenses from current/past year Refunds due pts for overpayment on their accoitn ️Accounts payable S corporation ️Similar to a C corp as they can issue stock but limited to the # of shareholders. All profit must be distributed in proportion to ownership %. Net income is not taxed at the entity level rather flows through the physicians personal tax return. What tool is used to determine where costs could be made? ️Income statement Cash-based Accounting System ️When purchases and expenses are reported the same month even if not being used until future dates. Marketing fres ️not reveue Cash Flow Statement ️A financial statement that shows the flow of money in and out of the business. What is the benefit of involving staff in a meeting to discuss reducing costs ️They maybe creative In cost savings measures to protect their jobs What is the advantage Of leasing equipment? ️Leased payments are deductible for income tax purposes Is the use of a budget useful to monitor the debt to equity ratio? ️No Accounts Payable ️Amounts to be paid in the future for goods or services already acquired Activity Based Costing ️A method of allocating overhead based on each product's use of activities in making the product. What items should be reviewed to reduce ongoing practice cost? ️Supplies, phone data plans, malpractice insurance and purchased services Limited liability corporation ️This structure allows unlimited owners and limits the amount of taxes What type of organization is beneficial in managing cost? ️GPO Salaries, rent and malpractice are examples of what type of expenses? ️Fixed expenses