CPPM STUDY GUIDE 2026/2027 QUESTIONS AND
SOLUTIONS RATED A+
✔✔Net Collection Rate - ✔✔Determines how well a business is collecting on eligible
revenue. Better to look at net collection rates over a 3-6-9-12 mo period of time
✔✔Net Collection Rate Formula - ✔✔Tot Receipts - Refunds ./. Tot Charges -
Contractual Adj
✔✔A/R Aging Summary - ✔✔Used to identify the aging of receivables & if accounts are
being collected in a timely manner
✔✔**PQRS - ✔✔Physicain Quality Reporting System = eligible providers are all health
care providers, but not out pt surgery center or labs
✔✔**PPACA - ✔✔Pt Protection & Affordable Act = allows sharing of IRS data to identfiy
fraudulent providers with tax debts
✔✔VOB - ✔✔Verification of Benefits
✔✔ROI - ✔✔Return on Investment
✔✔PECOS - ✔✔Provider Enrollment, Chain & Ownership System
✔✔Medicare EHHR Incentive Program - ✔✔does NOT include NPs, but does include
drs of MD, podiatrists, dentists, psychiatrists
✔✔VPN - ✔✔Virtual Private Network = extremely secure connections between private
networks tunneled through the internet
✔✔False Claims Act & Qui Tam - ✔✔Whistle Bloer Act - prohibits any person from
knowingly presenting or causing false claims
✔✔Rule by All - ✔✔all physician partners are involved in decision making
✔✔**Profit Share Plan - ✔✔contributions only by the employer; if offered to employer,
must be offered to employee
✔✔FMLA - ✔✔Family Medical Leave Act = only applies to employer groups with 50 or
more employees & gives up to 12 wks unpaid leave & holds the job
✔✔**EDI = Electronic Data Interchange - ✔✔Current version for HIPPA transactions is
X12 Version 5010, NCPDP Version D.0
, ✔✔HIPPA Breach - under 500 pts - ✔✔report once yearly
✔✔HIPPA Breech - over 500 pts - ✔✔but at least 12 pt addresses out of date, publish a
print ad of the breech in nespaper & include the date of the breech & when it was
discovered; a brief description of incident ; descriptioin of unsecured PHI involved &
suggested steps for individuals to take to protect against problems
✔✔HIPPA breech - over 500 pts - ✔✔must notify local media & notify Secretary of HHS
✔✔HIPPA - ✔✔applies to providers, health plans, clearinghouses, anyone who submits
any health info in an electronic manner
✔✔Business Associates Agreement - ✔✔needed when any entity is sharing PHI. NOT
used for employees. Also, NOT used for janitors, building maintenance or tax
accountants
✔✔HIPPA Breech of PHI of 45 records - ✔✔requires pt notification within 60 days of
breech
✔✔Offsite biller - ✔✔Required to log on to remote server that has automatic logoff
feature set
✔✔Subpoena for medical records - ✔✔You can send records requested by court order
without authorization from pt
✔✔Employment Questions OK to ask - ✔✔worked under different name
ever convicted of crime
if U.S. citizen
education level including degrees & certifications
If relatives employed by organizations
prior employment
✔✔Employment Questions NOT ok to ask - ✔✔age, race, sex, religion, national origin,
disability, pregnancy
✔✔401K - ✔✔Employer & employee BOTH contribute
✔✔HR forms kept in separate file from employee's personnel file & in locked location -
✔✔OSHA compliance
completed FMLA form
Employment eligibilty forms (INSS form 1-9)
Worker's compenstation
disability forms
SOLUTIONS RATED A+
✔✔Net Collection Rate - ✔✔Determines how well a business is collecting on eligible
revenue. Better to look at net collection rates over a 3-6-9-12 mo period of time
✔✔Net Collection Rate Formula - ✔✔Tot Receipts - Refunds ./. Tot Charges -
Contractual Adj
✔✔A/R Aging Summary - ✔✔Used to identify the aging of receivables & if accounts are
being collected in a timely manner
✔✔**PQRS - ✔✔Physicain Quality Reporting System = eligible providers are all health
care providers, but not out pt surgery center or labs
✔✔**PPACA - ✔✔Pt Protection & Affordable Act = allows sharing of IRS data to identfiy
fraudulent providers with tax debts
✔✔VOB - ✔✔Verification of Benefits
✔✔ROI - ✔✔Return on Investment
✔✔PECOS - ✔✔Provider Enrollment, Chain & Ownership System
✔✔Medicare EHHR Incentive Program - ✔✔does NOT include NPs, but does include
drs of MD, podiatrists, dentists, psychiatrists
✔✔VPN - ✔✔Virtual Private Network = extremely secure connections between private
networks tunneled through the internet
✔✔False Claims Act & Qui Tam - ✔✔Whistle Bloer Act - prohibits any person from
knowingly presenting or causing false claims
✔✔Rule by All - ✔✔all physician partners are involved in decision making
✔✔**Profit Share Plan - ✔✔contributions only by the employer; if offered to employer,
must be offered to employee
✔✔FMLA - ✔✔Family Medical Leave Act = only applies to employer groups with 50 or
more employees & gives up to 12 wks unpaid leave & holds the job
✔✔**EDI = Electronic Data Interchange - ✔✔Current version for HIPPA transactions is
X12 Version 5010, NCPDP Version D.0
, ✔✔HIPPA Breach - under 500 pts - ✔✔report once yearly
✔✔HIPPA Breech - over 500 pts - ✔✔but at least 12 pt addresses out of date, publish a
print ad of the breech in nespaper & include the date of the breech & when it was
discovered; a brief description of incident ; descriptioin of unsecured PHI involved &
suggested steps for individuals to take to protect against problems
✔✔HIPPA breech - over 500 pts - ✔✔must notify local media & notify Secretary of HHS
✔✔HIPPA - ✔✔applies to providers, health plans, clearinghouses, anyone who submits
any health info in an electronic manner
✔✔Business Associates Agreement - ✔✔needed when any entity is sharing PHI. NOT
used for employees. Also, NOT used for janitors, building maintenance or tax
accountants
✔✔HIPPA Breech of PHI of 45 records - ✔✔requires pt notification within 60 days of
breech
✔✔Offsite biller - ✔✔Required to log on to remote server that has automatic logoff
feature set
✔✔Subpoena for medical records - ✔✔You can send records requested by court order
without authorization from pt
✔✔Employment Questions OK to ask - ✔✔worked under different name
ever convicted of crime
if U.S. citizen
education level including degrees & certifications
If relatives employed by organizations
prior employment
✔✔Employment Questions NOT ok to ask - ✔✔age, race, sex, religion, national origin,
disability, pregnancy
✔✔401K - ✔✔Employer & employee BOTH contribute
✔✔HR forms kept in separate file from employee's personnel file & in locked location -
✔✔OSHA compliance
completed FMLA form
Employment eligibilty forms (INSS form 1-9)
Worker's compenstation
disability forms
