CPPM Test Questions And Answers A+
Graded
Productivity Report CORRECT ANSWERS Details the Volume of procedures being preformed by each provider
Denials report & Denials Rate CORRECT ANSWERS Important to cash flow - use weekly to identify denials. Should always stay below 5%
Adjustments to collection CORRECT ANSWERS Total # of denials ./. total claims submitted
**Adjustment to Collections Ratio Formula CORRECT ANSWERS Total adjustments for
period ./. Total collections for period
Net Collection Rate CORRECT ANSWERS Determines how well a business is collection on eligible revenue. Better to look at net
A/R Aging Summary CORRECT ANSWERS Used to identify the aging of receivables & if accounts are being collected in a timely manner.
PQRS CORRECT ANSWERS Physician Quality Reporting System - eligible providers are all health care providers, but not out pt surgery center or labs
PPACA CORRECT ANSWERS Patient Protection & Affordable Care Act - allows sharing of IRS data to identify fraudulent providers with tax debts.
VOB CORRECT ANSWERS Verification of Benefits
ROI CORRECT ANSWERS Return on Investment
PECOS CORRECT ANSWERS Provider Enrollment Chain Ownership System
Medicare EHHR Incentive Program CORRECT ANSWERS Does Not include NP's, but does include Dr's of MD, podiatrists, denitists, psychiatrists
VPN CORRECT ANSWERS Virtual Private Network - extremely secure connections between private networks tunneled through the internet.
False Claims Act & Qui Tam CORRECT ANSWERS Whistle Blower Act - prohibits any person from knowingly presenting or causing false claims
Rule by All CORRECT ANSWERS all physician partners are involved in decision making Profit Share Plan CORRECT ANSWERS contributions only by employer; if offered to employer, must be offered to employee
FMLA CORRECT ANSWERS 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 ANSWERS Curretn version for HIPPA transactions is X12 Version 5010, NCPDP Version D.0
HIPPA Breach under 500 patients CORRECT ANSWERS Reports once yearly
HIPPA Breach over 500 patients CORRECT ANSWERS but at least 12 patients addresses out of date, publish a print ad of the breach in newspaper & include the date of the breach, when it was discovered, a brief description of the incident, description of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 ANSWERS must notify local media and notify Secretary of HHS
HIPPA CORRECT ANSWERS applies to providers, health plans, clearinghouses, anyone who submits any health information in an electronic manner.
Business Associates Agreement CORRECT ANSWERS 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 ANSWERS requires patient notification within 60 days of the breech
Offsite biller CORRECT ANSWERS Required to log on to remote server that has automatic logoff feature set.
Subpoena for medical records CORRECT ANSWERS You can send records requested by court order without authorization for patient.
Employment Questions OK to ask CORRECT ANSWERS 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
Graded
Productivity Report CORRECT ANSWERS Details the Volume of procedures being preformed by each provider
Denials report & Denials Rate CORRECT ANSWERS Important to cash flow - use weekly to identify denials. Should always stay below 5%
Adjustments to collection CORRECT ANSWERS Total # of denials ./. total claims submitted
**Adjustment to Collections Ratio Formula CORRECT ANSWERS Total adjustments for
period ./. Total collections for period
Net Collection Rate CORRECT ANSWERS Determines how well a business is collection on eligible revenue. Better to look at net
A/R Aging Summary CORRECT ANSWERS Used to identify the aging of receivables & if accounts are being collected in a timely manner.
PQRS CORRECT ANSWERS Physician Quality Reporting System - eligible providers are all health care providers, but not out pt surgery center or labs
PPACA CORRECT ANSWERS Patient Protection & Affordable Care Act - allows sharing of IRS data to identify fraudulent providers with tax debts.
VOB CORRECT ANSWERS Verification of Benefits
ROI CORRECT ANSWERS Return on Investment
PECOS CORRECT ANSWERS Provider Enrollment Chain Ownership System
Medicare EHHR Incentive Program CORRECT ANSWERS Does Not include NP's, but does include Dr's of MD, podiatrists, denitists, psychiatrists
VPN CORRECT ANSWERS Virtual Private Network - extremely secure connections between private networks tunneled through the internet.
False Claims Act & Qui Tam CORRECT ANSWERS Whistle Blower Act - prohibits any person from knowingly presenting or causing false claims
Rule by All CORRECT ANSWERS all physician partners are involved in decision making Profit Share Plan CORRECT ANSWERS contributions only by employer; if offered to employer, must be offered to employee
FMLA CORRECT ANSWERS 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 ANSWERS Curretn version for HIPPA transactions is X12 Version 5010, NCPDP Version D.0
HIPPA Breach under 500 patients CORRECT ANSWERS Reports once yearly
HIPPA Breach over 500 patients CORRECT ANSWERS 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 ANSWERS must notify local media and notify Secretary of HHS
HIPPA CORRECT ANSWERS applies to providers, health plans, clearinghouses, anyone who submits any health information in an electronic manner.
Business Associates Agreement CORRECT ANSWERS 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 ANSWERS requires patient notification within 60 days of the breech
Offsite biller CORRECT ANSWERS Required to log on to remote server that has automatic logoff feature set.
Subpoena for medical records CORRECT ANSWERS You can send records requested by court order without authorization for patient.
Employment Questions OK to ask CORRECT ANSWERS 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
