CPPM EXAM PREP QUESTIONS WITH 100%
ACCURATE ANSWERS
Revenue Per Visit (RPV) - Accurate answers Total amount collected divides by the total number of
patient visits
Advance Benefit Notification (ABN) - Accurate answers Notification given to patients advising
Medicare may not cover a certain procedure or service
Payment for fee for service is based on - Accurate answers CPT & HCPCS Level II
MCO - Accurate answers Private Health Plan
Place of Service (POS) determines correct reimbursement when - Accurate answers The
professional component for services provided in a facility (I.e. HOD) are less than when provided in a
physician office as the physician doesn't have any practice expense at the facility. (In private practice
they pay rent, staff etc whereas is HOD these are paid by the facility)
DEA number - Accurate answers Is not needed for the online application to CMS for an NPI
Customer service, optimizing physician time and claim quality assurance are key components to which
role? - Accurate answers Front Desk
What can result in claim denial? - Accurate answers Incorrect POS, incorrect NPI, and a truncated
diagnosis code
Patients are prepared to make payments at the time of there visits when? - Accurate answers
Payment & collection policies are prominently posted in the office
What is the most important criteria to meet for the selection of Evaluation and Management (E/M)
codes? - Accurate answers Medical necessity
What code set represents healthcare equipment, drugs and supplies? - Accurate answers ICD-
10.PCS
ICD-10-CM - Accurate answers International Classification of Diseases, Tenth Revision, Clinical
Modification CM codes represent the diagnosis/reason a service is performed.
ICD-10-PCS - Accurate answers International Classification of Diseases, Revision Procedural Coding
System. These represent procedures performed at inpatient hospital facilities
CPT codes - Accurate answers current procedural terminology represent procedures performed &
bilked by physicians and non-physicians practitioners (APP's)
, HCPCS Level II - Accurate answers for products and supplies and services not included in level I. the
code is alphanumeric
Clean Claim Form - Accurate answers A form that is complete and accurate and includes all
provider information and other additional information to process for payment
History of present illness - Accurate answers Chronological description of the development of
patients complaint
Which codes are used by physicians and APP's to report professional services? - Accurate answers
CPT & HCPCS Level Ii
Procedure codes are reported using which codes? - Accurate answers CPT
Medicare patient with Parts A, B & C and no fault auto insurance is seen in the ED following a minor auto
accident, who is the primary insurance? - Accurate answers Auto No-Fault
What is the first thing to review when a private payer repeatedly denies a specific code (o.e.
Venipuncture)? - Accurate answers Payer Contract to see if denial is appropriate
Vital component of medical coding - Accurate answers Codes based on complete and accurate
medical record documentation in the patients chart
How often should you run a productivity report? - Accurate answers Twice a year, minimally
What is one purpose for a productivity report? - Accurate answers To verify a good payer mix for a
strong revenue stream
What can add to an inefficient bad debt management process? - Accurate answers Numerous
clinical & administrative approval requirements, unclear policies on write-off thresholds, and unclear
policies that limit the amount of balance billing
Capitation payment - Accurate answers A prospective method of payment. Payments are based on
a physician fee schedules negotiated with the payer.
What accounts should be considered for collection? - Accurate answers 90+ days with a balance
greater than $10
What should you consider when conducting a registration audit? - Accurate answers Address,
phone #, employer, insurance verification, and co-pay collected
Three indicators for monitoring receivables - Accurate answers Net collection rate, denials, and
A/R days
Three components to having claims paid by payer - Accurate answers Procedure code, diagnosis
code(s), and insurance policy number
ACCURATE ANSWERS
Revenue Per Visit (RPV) - Accurate answers Total amount collected divides by the total number of
patient visits
Advance Benefit Notification (ABN) - Accurate answers Notification given to patients advising
Medicare may not cover a certain procedure or service
Payment for fee for service is based on - Accurate answers CPT & HCPCS Level II
MCO - Accurate answers Private Health Plan
Place of Service (POS) determines correct reimbursement when - Accurate answers The
professional component for services provided in a facility (I.e. HOD) are less than when provided in a
physician office as the physician doesn't have any practice expense at the facility. (In private practice
they pay rent, staff etc whereas is HOD these are paid by the facility)
DEA number - Accurate answers Is not needed for the online application to CMS for an NPI
Customer service, optimizing physician time and claim quality assurance are key components to which
role? - Accurate answers Front Desk
What can result in claim denial? - Accurate answers Incorrect POS, incorrect NPI, and a truncated
diagnosis code
Patients are prepared to make payments at the time of there visits when? - Accurate answers
Payment & collection policies are prominently posted in the office
What is the most important criteria to meet for the selection of Evaluation and Management (E/M)
codes? - Accurate answers Medical necessity
What code set represents healthcare equipment, drugs and supplies? - Accurate answers ICD-
10.PCS
ICD-10-CM - Accurate answers International Classification of Diseases, Tenth Revision, Clinical
Modification CM codes represent the diagnosis/reason a service is performed.
ICD-10-PCS - Accurate answers International Classification of Diseases, Revision Procedural Coding
System. These represent procedures performed at inpatient hospital facilities
CPT codes - Accurate answers current procedural terminology represent procedures performed &
bilked by physicians and non-physicians practitioners (APP's)
, HCPCS Level II - Accurate answers for products and supplies and services not included in level I. the
code is alphanumeric
Clean Claim Form - Accurate answers A form that is complete and accurate and includes all
provider information and other additional information to process for payment
History of present illness - Accurate answers Chronological description of the development of
patients complaint
Which codes are used by physicians and APP's to report professional services? - Accurate answers
CPT & HCPCS Level Ii
Procedure codes are reported using which codes? - Accurate answers CPT
Medicare patient with Parts A, B & C and no fault auto insurance is seen in the ED following a minor auto
accident, who is the primary insurance? - Accurate answers Auto No-Fault
What is the first thing to review when a private payer repeatedly denies a specific code (o.e.
Venipuncture)? - Accurate answers Payer Contract to see if denial is appropriate
Vital component of medical coding - Accurate answers Codes based on complete and accurate
medical record documentation in the patients chart
How often should you run a productivity report? - Accurate answers Twice a year, minimally
What is one purpose for a productivity report? - Accurate answers To verify a good payer mix for a
strong revenue stream
What can add to an inefficient bad debt management process? - Accurate answers Numerous
clinical & administrative approval requirements, unclear policies on write-off thresholds, and unclear
policies that limit the amount of balance billing
Capitation payment - Accurate answers A prospective method of payment. Payments are based on
a physician fee schedules negotiated with the payer.
What accounts should be considered for collection? - Accurate answers 90+ days with a balance
greater than $10
What should you consider when conducting a registration audit? - Accurate answers Address,
phone #, employer, insurance verification, and co-pay collected
Three indicators for monitoring receivables - Accurate answers Net collection rate, denials, and
A/R days
Three components to having claims paid by payer - Accurate answers Procedure code, diagnosis
code(s), and insurance policy number
