CPPM UPDATED Exam Questions and
CORRECT Answers
Productivity Report - CORRECT ANSWER Details the Volume of procedures being
preformed by each provider
Denials report & Denials Rate - CORRECT ANSWER Important to cash flow - use weekly to
identify denials. Should always stay below 5%
Adjustments to collection - CORRECT ANSWER Total # of denials ./. total claims submitted
**Adjustment to Collections Ratio Formula - CORRECT ANSWER Total adjustments for
period ./. Total collections for period
Net Collection Rate - CORRECT ANSWER Determines how well a business is collection on
eligible revenue. Better to look at net
A/R Aging Summary - CORRECT ANSWER Used to identify the aging of receivables & if
accounts are being collected in a timely manner.
PQRS - CORRECT ANSWER Physician Quality Reporting System - eligible providers are all
health care providers, but not out pt surgery center or labs
PPACA - CORRECT ANSWER Patient Protection & Affordable Care Act - allows sharing of
IRS data to identify fraudulent providers with tax debts.
VOB - CORRECT ANSWER Verification of Benefits
ROI - CORRECT ANSWER Return on Investment
,PECOS - CORRECT ANSWER Provider Enrollment Chain Ownership System
Medicare EHHR Incentive Program - CORRECT ANSWER Does Not include NP's, but does
include Dr's of MD, podiatrists, denitists, psychiatrists
VPN - CORRECT ANSWER Virtual Private Network - extremely secure connections
between private networks tunneled through the internet.
False Claims Act & Qui Tam - CORRECT ANSWER Whistle Blower Act - prohibits any
person from knowingly presenting or causing false claims
Rule by All - CORRECT ANSWER all physician partners are involved in decision making
Profit Share Plan - CORRECT ANSWER contributions only by employer; if offered to
employer, must be offered to employee
FMLA - CORRECT ANSWER Family Medical Leave Act - only applies to employer groups
with 50 or more employees & gives up to 12 weeks unpaid leave and holds the job.
EDI Electronic Data Interchange - CORRECT ANSWER Curretn version for HIPPA
transactions is X12 Version 5010, NCPDP Version D.0
HIPPA Breach under 500 patients - CORRECT ANSWER Reports once yearly
HIPPA Breach over 500 patients - CORRECT ANSWER but at least 12 patients addresses out
of date, publish a print ad of the breach in newspaper & include the date of the breach, when it
was discovered, a brief description of the incident, description of unsecured PHI involved and
suggested steps for the individual to take to protect against problems.
HIPPA Breach over 500 patients* - CORRECT ANSWER must notify local media and notify
Secretary of HHS
, HIPPA - CORRECT ANSWER applies to providers, health plans, clearinghouses, anyone
who submits any health information in an electronic manner.
Business Associates Agreement - CORRECT ANSWER needed when an entity is sharing
PHI. NOt used for employees, Also Not used for janitors, building maintenance or tax
accountants.
HIPPA Breach of PHI of 45 records - CORRECT ANSWER requires patient notification
within 60 days of the breech
Offsite biller - CORRECT ANSWER Required to log on to remote server that has automatic
logoff feature set.
Subpoena for medical records - CORRECT ANSWER You can send records requested by
court order without authorization for patient.
Employment Questions OK to ask - CORRECT ANSWER worked under a different name
ever convicted of a crime
if U.S. citizen
education level including degrees & certifications
If relatives employed by organizations
prior employment
Employment Questions NOT OK to ask - CORRECT ANSWER age, race, sex, religion,
national origin, disability, pregnancy
401K - CORRECT ANSWER Employer & Employee Both Contribute
CORRECT Answers
Productivity Report - CORRECT ANSWER Details the Volume of procedures being
preformed by each provider
Denials report & Denials Rate - CORRECT ANSWER Important to cash flow - use weekly to
identify denials. Should always stay below 5%
Adjustments to collection - CORRECT ANSWER Total # of denials ./. total claims submitted
**Adjustment to Collections Ratio Formula - CORRECT ANSWER Total adjustments for
period ./. Total collections for period
Net Collection Rate - CORRECT ANSWER Determines how well a business is collection on
eligible revenue. Better to look at net
A/R Aging Summary - CORRECT ANSWER Used to identify the aging of receivables & if
accounts are being collected in a timely manner.
PQRS - CORRECT ANSWER Physician Quality Reporting System - eligible providers are all
health care providers, but not out pt surgery center or labs
PPACA - CORRECT ANSWER Patient Protection & Affordable Care Act - allows sharing of
IRS data to identify fraudulent providers with tax debts.
VOB - CORRECT ANSWER Verification of Benefits
ROI - CORRECT ANSWER Return on Investment
,PECOS - CORRECT ANSWER Provider Enrollment Chain Ownership System
Medicare EHHR Incentive Program - CORRECT ANSWER Does Not include NP's, but does
include Dr's of MD, podiatrists, denitists, psychiatrists
VPN - CORRECT ANSWER Virtual Private Network - extremely secure connections
between private networks tunneled through the internet.
False Claims Act & Qui Tam - CORRECT ANSWER Whistle Blower Act - prohibits any
person from knowingly presenting or causing false claims
Rule by All - CORRECT ANSWER all physician partners are involved in decision making
Profit Share Plan - CORRECT ANSWER contributions only by employer; if offered to
employer, must be offered to employee
FMLA - CORRECT ANSWER Family Medical Leave Act - only applies to employer groups
with 50 or more employees & gives up to 12 weeks unpaid leave and holds the job.
EDI Electronic Data Interchange - CORRECT ANSWER Curretn version for HIPPA
transactions is X12 Version 5010, NCPDP Version D.0
HIPPA Breach under 500 patients - CORRECT ANSWER Reports once yearly
HIPPA Breach over 500 patients - CORRECT ANSWER but at least 12 patients addresses out
of date, publish a print ad of the breach in newspaper & include the date of the breach, when it
was discovered, a brief description of the incident, description of unsecured PHI involved and
suggested steps for the individual to take to protect against problems.
HIPPA Breach over 500 patients* - CORRECT ANSWER must notify local media and notify
Secretary of HHS
, HIPPA - CORRECT ANSWER applies to providers, health plans, clearinghouses, anyone
who submits any health information in an electronic manner.
Business Associates Agreement - CORRECT ANSWER needed when an entity is sharing
PHI. NOt used for employees, Also Not used for janitors, building maintenance or tax
accountants.
HIPPA Breach of PHI of 45 records - CORRECT ANSWER requires patient notification
within 60 days of the breech
Offsite biller - CORRECT ANSWER Required to log on to remote server that has automatic
logoff feature set.
Subpoena for medical records - CORRECT ANSWER You can send records requested by
court order without authorization for patient.
Employment Questions OK to ask - CORRECT ANSWER worked under a different name
ever convicted of a crime
if U.S. citizen
education level including degrees & certifications
If relatives employed by organizations
prior employment
Employment Questions NOT OK to ask - CORRECT ANSWER age, race, sex, religion,
national origin, disability, pregnancy
401K - CORRECT ANSWER Employer & Employee Both Contribute
