CMOM PRACTICE MANAGEMENT INSTITUTE EXAM SCRIPT
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔Budget Planning - ✔✔for optimum results evaluate the past 3 years of income and
expense in order to prepare your projected budget. Hint*A good manager will plan a
budget a year in advance.
✔✔What influences your budget? - ✔✔-Inflation (barrier)
-HIPPA (to be compliant)
-OSHA (Providing that annual training being compliant)
-Having a billing compliance plan
-New Services (Medicine changes)
-Labor Costs (finding qualified people)
-Competition (Location, Services, Marketing)
✔✔Forecasting - ✔✔to make an estimate of the number of new patients visits over the
past 3-4 years.
✔✔High overhead - ✔✔suggests at least some
-low patient volume
-excess expense
-overstaffing or inefficient staffing
-poor managed care contracts
✔✔Low overhead - ✔✔normally seen as a "positive" indication it can indicate an
underlying problem for the future
-inequitably high fees
-lack of proper patient management
-failure to deliver high quality medical care
-understaffing or low salary
✔✔Strategic Plan - ✔✔working with outside consultants is vital. An up-to-date plan
helps the owners/physicians ascertain the current position of the practice, and hopefully
where it is going in the future.
✔✔Flash report - ✔✔should be short and straight to the point its an excellent method of
communicating patient stats and financial information.
✔✔Net charges - ✔✔Gross-adjustments=net charges
✔✔Why Dollars Lost? - ✔✔4 main reasons why dollars get lost in practices
-Poor financial management
-Incorrect coding
-Lack of third party payer knowledge
-Lack of employee education
, ✔✔Collecting co-pay for divorced cases - ✔✔the adult seeking treatment is responsible
for the bill. The person bringing the child is still responsible to you for payment, the
patient can bill their estranged, but not responsibility of the practice.
✔✔Contract Law* - ✔✔in order to bill insurance there needs to be a SSN in place as an
identifier of the patient and to improve on identity theft.
✔✔Federal Fair Credit Billing Act - ✔✔"to protect the consumer against inaccurate and
unfair credit billing"
✔✔Fee Schedule Changes to consider... - ✔✔competition is a factor to consider when
making changes to a fee schedule
✔✔Embezzlement - ✔✔occurs when someone fraudulently signs or alters documents,
usually checks, with change to the financial obligations of the practice.
✔✔Managed Care Accrediting Organizations - ✔✔-National Committee for Quality
Insurance (NCQA)
-Joint Commission on Accreditation of Healthcare (JCAHO)
-American Accreditation HealthCare Commission (AAHCC)
-Medical Quality Commission (MQC)
✔✔Preferred Provider Organization PPO
(In Network and Out of Network) - ✔✔In Network: contracted providers. Patients will
have,
-Low Co-pay
-Low Deductible
-Little out-of-pocket expense
Out of Network: go outside of the contract physician list.
-High deductible
-High Co-pay
-High out-of-pocket expense
✔✔Silent PPO - ✔✔plan that has two ways to access your contracted discount fee.
behind the scenes take your info and give a less reimbursement.
✔✔Health Maintenance Organizations (HMO) - ✔✔Typically have a co-pay that there
responsible for and require referral for specialists, typically every three months.
✔✔Types of HMO's - ✔✔Group Model-private practice physicians, including hospitals
Network Model-contracts with one or more multi-specialty clinics
Staff Model-providers are employees of HMO and they provide services to those HMO
beneficiaries
2025/2026 QUESTIONS WITH ANSWERS GRADED A+
✔✔Budget Planning - ✔✔for optimum results evaluate the past 3 years of income and
expense in order to prepare your projected budget. Hint*A good manager will plan a
budget a year in advance.
✔✔What influences your budget? - ✔✔-Inflation (barrier)
-HIPPA (to be compliant)
-OSHA (Providing that annual training being compliant)
-Having a billing compliance plan
-New Services (Medicine changes)
-Labor Costs (finding qualified people)
-Competition (Location, Services, Marketing)
✔✔Forecasting - ✔✔to make an estimate of the number of new patients visits over the
past 3-4 years.
✔✔High overhead - ✔✔suggests at least some
-low patient volume
-excess expense
-overstaffing or inefficient staffing
-poor managed care contracts
✔✔Low overhead - ✔✔normally seen as a "positive" indication it can indicate an
underlying problem for the future
-inequitably high fees
-lack of proper patient management
-failure to deliver high quality medical care
-understaffing or low salary
✔✔Strategic Plan - ✔✔working with outside consultants is vital. An up-to-date plan
helps the owners/physicians ascertain the current position of the practice, and hopefully
where it is going in the future.
✔✔Flash report - ✔✔should be short and straight to the point its an excellent method of
communicating patient stats and financial information.
✔✔Net charges - ✔✔Gross-adjustments=net charges
✔✔Why Dollars Lost? - ✔✔4 main reasons why dollars get lost in practices
-Poor financial management
-Incorrect coding
-Lack of third party payer knowledge
-Lack of employee education
, ✔✔Collecting co-pay for divorced cases - ✔✔the adult seeking treatment is responsible
for the bill. The person bringing the child is still responsible to you for payment, the
patient can bill their estranged, but not responsibility of the practice.
✔✔Contract Law* - ✔✔in order to bill insurance there needs to be a SSN in place as an
identifier of the patient and to improve on identity theft.
✔✔Federal Fair Credit Billing Act - ✔✔"to protect the consumer against inaccurate and
unfair credit billing"
✔✔Fee Schedule Changes to consider... - ✔✔competition is a factor to consider when
making changes to a fee schedule
✔✔Embezzlement - ✔✔occurs when someone fraudulently signs or alters documents,
usually checks, with change to the financial obligations of the practice.
✔✔Managed Care Accrediting Organizations - ✔✔-National Committee for Quality
Insurance (NCQA)
-Joint Commission on Accreditation of Healthcare (JCAHO)
-American Accreditation HealthCare Commission (AAHCC)
-Medical Quality Commission (MQC)
✔✔Preferred Provider Organization PPO
(In Network and Out of Network) - ✔✔In Network: contracted providers. Patients will
have,
-Low Co-pay
-Low Deductible
-Little out-of-pocket expense
Out of Network: go outside of the contract physician list.
-High deductible
-High Co-pay
-High out-of-pocket expense
✔✔Silent PPO - ✔✔plan that has two ways to access your contracted discount fee.
behind the scenes take your info and give a less reimbursement.
✔✔Health Maintenance Organizations (HMO) - ✔✔Typically have a co-pay that there
responsible for and require referral for specialists, typically every three months.
✔✔Types of HMO's - ✔✔Group Model-private practice physicians, including hospitals
Network Model-contracts with one or more multi-specialty clinics
Staff Model-providers are employees of HMO and they provide services to those HMO
beneficiaries
