CSPPM Study Guide (Certified Specialist
Physician Practice Management)
Encounter
Patient treatment at some stage in a defined period. A single-date occurrence at a single
company
Purpose of Encounter
To provide information to the coverage plan approximately the treatment the patient
acquired.
Encounter report
* Patient & Provider demographic
*Detailed charges and services
*Clinical facts particular to the come upon
CMS 1500
form for the stumble upon processing
Time body for Encounter reports to be submitted?
Inside seventy two hours
DAR
Days Accounts Receivable
Key performance indicators (KPIs) for effective claims managment
DAR
What will reduce the exercise DAR?
Timely submitting encounters
EDI
Electronic Date Interchange
,Used to have an instantaneous digital receipt and provide edit and audit reviews?
EDI
Customer Patient Surveys
Tools to measure effective customer and affected person members of the family
Advantage of Internal Surveys
*Address without delay the problems of importance to the exercise
*Less highly-priced than an external survey
*Can monitor trends over the years
Disadvantage of Internal Surveys
*Relaying on health practitioner and personnel to provide you with questions
*Skills units to validate and expand questions
*Patients will no longer solution questions if the group of workers is reviewing the questions
Advantage of External Surveys
*Professional revel in to develop and validate the survey
*Provides benchmark overall performance from different practices
Disadvantage of External Surveys
*Cash out of pocket price
Methods of Pre-Registration
*Online affected person registration by affected person or team of workers
*Mailing of latest patient form
*Telephone call
Fee-for-Service
Encounter paid at a gotten smaller rate and implemented to charge
Continuum of care
*Referred strong point care
*Outside diagnostic trying out services
*Rehabilitation offerings
*Local Hospital Services
Components to manage hazard
*Health Information Systems
, *Medical Records Documentation
*Quality Assurance Programs
*Case Management
Management of Third-celebration Receivables
*Encounter documented with retail prices
*Produce a claim or digital layout
*All required documentation is connected
ICD-10
Created in May 1990 with the aid of the 43rd World Health Assembly
ICD
International type of diseases
Contains approximately 70,000 codes
ICD-10
What diagnosis codes that can not be coded?
*Probable
*Suspected
*Questionable
*Ruled out
AMA
American Medical Association
CPT
Current Procedural Terminology
Who posted the CPT?
AMA (American Medical Association)
CPT five sections
*Surgery
*Anesthesia
*Pathology
*Radiology
*E/M offerings
Physician Practice Management)
Encounter
Patient treatment at some stage in a defined period. A single-date occurrence at a single
company
Purpose of Encounter
To provide information to the coverage plan approximately the treatment the patient
acquired.
Encounter report
* Patient & Provider demographic
*Detailed charges and services
*Clinical facts particular to the come upon
CMS 1500
form for the stumble upon processing
Time body for Encounter reports to be submitted?
Inside seventy two hours
DAR
Days Accounts Receivable
Key performance indicators (KPIs) for effective claims managment
DAR
What will reduce the exercise DAR?
Timely submitting encounters
EDI
Electronic Date Interchange
,Used to have an instantaneous digital receipt and provide edit and audit reviews?
EDI
Customer Patient Surveys
Tools to measure effective customer and affected person members of the family
Advantage of Internal Surveys
*Address without delay the problems of importance to the exercise
*Less highly-priced than an external survey
*Can monitor trends over the years
Disadvantage of Internal Surveys
*Relaying on health practitioner and personnel to provide you with questions
*Skills units to validate and expand questions
*Patients will no longer solution questions if the group of workers is reviewing the questions
Advantage of External Surveys
*Professional revel in to develop and validate the survey
*Provides benchmark overall performance from different practices
Disadvantage of External Surveys
*Cash out of pocket price
Methods of Pre-Registration
*Online affected person registration by affected person or team of workers
*Mailing of latest patient form
*Telephone call
Fee-for-Service
Encounter paid at a gotten smaller rate and implemented to charge
Continuum of care
*Referred strong point care
*Outside diagnostic trying out services
*Rehabilitation offerings
*Local Hospital Services
Components to manage hazard
*Health Information Systems
, *Medical Records Documentation
*Quality Assurance Programs
*Case Management
Management of Third-celebration Receivables
*Encounter documented with retail prices
*Produce a claim or digital layout
*All required documentation is connected
ICD-10
Created in May 1990 with the aid of the 43rd World Health Assembly
ICD
International type of diseases
Contains approximately 70,000 codes
ICD-10
What diagnosis codes that can not be coded?
*Probable
*Suspected
*Questionable
*Ruled out
AMA
American Medical Association
CPT
Current Procedural Terminology
Who posted the CPT?
AMA (American Medical Association)
CPT five sections
*Surgery
*Anesthesia
*Pathology
*Radiology
*E/M offerings
