CSPPM Study Guide (Certified Specialist Physician Practice Managemen
Study online at https://quizlet.com/_1gte0v
1. Encounter Patient treatment during a defined period. A single-date occurrence
at a single provider
2. Purpose of Encounter To provide info to the insurance plan about the treatment the patient
received.
3. Encounter report * Patient & Provider demographic
*Detailed charges and services
*Clinical information specific to the encounter
4. CMS 1500 form for the encounter processing
5. Time frame for En- within 72 hours
counter reports to be
submitted?
6. DAR Days Accounts Receivable
7. Key performance indica- DAR
tors (KPIs) for effective
claims managment
8. What will reduce the Timely submitting encounters
practice DAR?
9. EDI Electronic Date Interchange
10. Used to have an immedi- EDI
ate electronic receipt and
provide edit and audit re-
ports?
11. Customer Patient Sur- Tools to measure effective customer and patient relations
veys
, CSPPM Study Guide (Certified Specialist Physician Practice Managemen
Study online at https://quizlet.com/_1gte0v
12. Advantage of Internal *Address directly the issues of importance to the practice
Surveys *Less expensive than an external survey
*Can monitor trends over time
13. Disadvantage of Internal *Relaying on physician and staff to come up with questions
Surveys *Skills sets to validate and develop questions
*Patients will not answer questions if the staff is reviewing the ques-
tions
14. Advantage of External *Professional experience to develop and validate the survey
Surveys *Provides benchmark performance from other practices
15. Disadvantage of External *Cash out of pocket cost
Surveys
16. Methods of Pre-Registra- *Online patient registration by patient or staff
tion *Mailing of new patient form
*Telephone call
17. Fee-for-Service Encounter paid at a contracted rate and applied to charge
18. Continuum of care *Referred specialty care
*Outside diagnostic testing services
*Rehabilitation services
*Local Hospital Services
19. Components to manage *Health Information Systems
risk *Medical Records Documentation
*Quality Assurance Programs
*Case Management
20. Management of
Third-party Receivables
, CSPPM Study Guide (Certified Specialist Physician Practice Managemen
Study online at https://quizlet.com/_1gte0v
*Encounter documented with retail charges
*Produce a claim or electronic format
*All required documentation is attached
21. ICD-10 Created in May 1990 by the 43rd World Health Assembly
22. ICD International classification of diseases
23. Contains about 70,000 ICD-10
codes
24. What diagnosis codes *Probable
that can not be coded? *Suspected
*Questionable
*Ruled out
25. AMA American Medical Association
26. CPT Current Procedural Terminology
27. Who published the CPT? AMA (American Medical Association)
28. CPT 5 sections *Surgery
*Anesthesia
*Pathology
*Radiology
*E/M services
29. EHR Electronic health record
30. What is not a key compo- Time
nent of E/M services?
31. RBRVS Resource Based Relative Value System
, CSPPM Study Guide (Certified Specialist Physician Practice Managemen
Study online at https://quizlet.com/_1gte0v
32. Based on the principle RBRVS
that payments for physi-
cians services should
vary with the resource
cost for providing those
services and is intend-
ed to improve and stabi-
lize the payment system
while providing physician
an avenue to improve it
33. Three Components of Re- *Work related value (measure of skill, training, and knowledge)
source Consumption: *Physical resource or cost
*Cost associated with malpractice insurance
34. RVU Relative Value Unit
35. GPCI Geographic Practice Cost Index
36. Applications for internal *Expense per RVU
and external benchmark- *Gross charge per RVU
ing: *Net revenue per RVU
*RVUs per physician
*RVU productivity by specialty
*RVUs per medical support staff FTE
*RVUs per visit
*Ratio of compensation per RVU
37. Who is responsible for ac- Physicians
curate and correct use of
CPT codes?
38. Revenue Cycle Functions
Study online at https://quizlet.com/_1gte0v
1. Encounter Patient treatment during a defined period. A single-date occurrence
at a single provider
2. Purpose of Encounter To provide info to the insurance plan about the treatment the patient
received.
3. Encounter report * Patient & Provider demographic
*Detailed charges and services
*Clinical information specific to the encounter
4. CMS 1500 form for the encounter processing
5. Time frame for En- within 72 hours
counter reports to be
submitted?
6. DAR Days Accounts Receivable
7. Key performance indica- DAR
tors (KPIs) for effective
claims managment
8. What will reduce the Timely submitting encounters
practice DAR?
9. EDI Electronic Date Interchange
10. Used to have an immedi- EDI
ate electronic receipt and
provide edit and audit re-
ports?
11. Customer Patient Sur- Tools to measure effective customer and patient relations
veys
, CSPPM Study Guide (Certified Specialist Physician Practice Managemen
Study online at https://quizlet.com/_1gte0v
12. Advantage of Internal *Address directly the issues of importance to the practice
Surveys *Less expensive than an external survey
*Can monitor trends over time
13. Disadvantage of Internal *Relaying on physician and staff to come up with questions
Surveys *Skills sets to validate and develop questions
*Patients will not answer questions if the staff is reviewing the ques-
tions
14. Advantage of External *Professional experience to develop and validate the survey
Surveys *Provides benchmark performance from other practices
15. Disadvantage of External *Cash out of pocket cost
Surveys
16. Methods of Pre-Registra- *Online patient registration by patient or staff
tion *Mailing of new patient form
*Telephone call
17. Fee-for-Service Encounter paid at a contracted rate and applied to charge
18. Continuum of care *Referred specialty care
*Outside diagnostic testing services
*Rehabilitation services
*Local Hospital Services
19. Components to manage *Health Information Systems
risk *Medical Records Documentation
*Quality Assurance Programs
*Case Management
20. Management of
Third-party Receivables
, CSPPM Study Guide (Certified Specialist Physician Practice Managemen
Study online at https://quizlet.com/_1gte0v
*Encounter documented with retail charges
*Produce a claim or electronic format
*All required documentation is attached
21. ICD-10 Created in May 1990 by the 43rd World Health Assembly
22. ICD International classification of diseases
23. Contains about 70,000 ICD-10
codes
24. What diagnosis codes *Probable
that can not be coded? *Suspected
*Questionable
*Ruled out
25. AMA American Medical Association
26. CPT Current Procedural Terminology
27. Who published the CPT? AMA (American Medical Association)
28. CPT 5 sections *Surgery
*Anesthesia
*Pathology
*Radiology
*E/M services
29. EHR Electronic health record
30. What is not a key compo- Time
nent of E/M services?
31. RBRVS Resource Based Relative Value System
, CSPPM Study Guide (Certified Specialist Physician Practice Managemen
Study online at https://quizlet.com/_1gte0v
32. Based on the principle RBRVS
that payments for physi-
cians services should
vary with the resource
cost for providing those
services and is intend-
ed to improve and stabi-
lize the payment system
while providing physician
an avenue to improve it
33. Three Components of Re- *Work related value (measure of skill, training, and knowledge)
source Consumption: *Physical resource or cost
*Cost associated with malpractice insurance
34. RVU Relative Value Unit
35. GPCI Geographic Practice Cost Index
36. Applications for internal *Expense per RVU
and external benchmark- *Gross charge per RVU
ing: *Net revenue per RVU
*RVUs per physician
*RVU productivity by specialty
*RVUs per medical support staff FTE
*RVUs per visit
*Ratio of compensation per RVU
37. Who is responsible for ac- Physicians
curate and correct use of
CPT codes?
38. Revenue Cycle Functions
