CPPM Quiz - Questions With Correct Solutions (100%)
Productivity Report Right Ans - Details the Volume of procedures being
performed by each provider
Denials report & Denials Rate Right Ans - Important to cash flow - use
weekly to identify denials. Should always stay below 5%
Adjustments to collection Right Ans - Total # of denials ./. total claims
submitted
**Adjustment to Collections Ratio Formula Right Ans - Total adjustments
for period ./. Total collections for period
Net Collection Rate Right Ans - Determines how well a business is
collection on eligible revenue. Better to look at net
A/R Aging Summary Right Ans - Used to identify the aging of receivables &
if accounts are being collected in a timely manner.
PQRS Right Ans - Physician Quality Reporting System - eligible providers
are all health care providers, but not out pt surgery center or labs
PPACA Right Ans - Patient Protection & Affordable Care Act - allows
sharing of IRS data to identify fraudulent providers with tax debts.
VOB Right Ans - Verification of Benefits
ROI Right Ans - Return on Investment
PECOS Right Ans - Provider Enrollment Chain Ownership System
Medicare EHHR Incentive Program Right Ans - Does Not include NP's, but
does include Dr's of MD, podiatrists, denitists, psychiatrists
VPN Right Ans - Virtual Private Network - extremely secure connections
between private networks tunneled through the internet.
,False Claims Act & Qui Tam Right Ans - Whistle Blower Act - prohibits any
person from knowingly presenting or causing false claims
Rule by All Right Ans - all physician partners are involved in decision
making
Profit Share Plan Right Ans - contributions only by employer; if offered to
employer, must be offered to employee
FMLA Right Ans - 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 Right Ans - Curretn version for HIPPA
transactions is X12 Version 5010, NCPDP Version D.0
HIPPA Breach under 500 patients Right Ans - Reports once yearly
HIPPA Breach over 500 patients Right Ans - 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addresses out of date, publish a print ad of the breach in newspaper & include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* Right Ans - must notify local media and
notify Secretary of HHS
HIPPA Right Ans - applies to providers, health plans, clearinghouses,
anyone who submits any health information in an electronic manner.
Business Associates Agreement Right Ans - 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 Right Ans - requires patient notification
within 60 days of the breech
Offsite biller Right Ans - Required to log on to remote server that has
automatic logoff feature set.
, Subpoena for medical records Right Ans - You can send records requested
by court order without authorization for patient.
Employment Questions OK to ask Right Ans - 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 Right Ans - age, race, sex, religion,
national origin, disability, pregnancy
401K Right Ans - Employer & Employee Both Contribute
HR forms kept in a sperate file from employee's personnell file & in a locked
location Right Ans - OSHA Compliance
completed FMLA form
Employment eligibility forms INSS form I-9
Worker's compensation
disability forms
Income Statement Model Right Ans - This physician compensation model
requires allocation of revenue & expenses to each physician in the practice
Mid Levels Right Ans - Need Standard of Care agreement if only billing
incident to
SWOT Analysis Right Ans - Strengths, Weakness, Opportunities, Threats
Anti-Kickback Law Right Ans - can't solicit or receive payment for patient
referrals
Compliance Plan Right Ans - Includes: designated compliance officer
training & education
Written policies for denial mgmt software
Internal auditing
Productivity Report Right Ans - Details the Volume of procedures being
performed by each provider
Denials report & Denials Rate Right Ans - Important to cash flow - use
weekly to identify denials. Should always stay below 5%
Adjustments to collection Right Ans - Total # of denials ./. total claims
submitted
**Adjustment to Collections Ratio Formula Right Ans - Total adjustments
for period ./. Total collections for period
Net Collection Rate Right Ans - Determines how well a business is
collection on eligible revenue. Better to look at net
A/R Aging Summary Right Ans - Used to identify the aging of receivables &
if accounts are being collected in a timely manner.
PQRS Right Ans - Physician Quality Reporting System - eligible providers
are all health care providers, but not out pt surgery center or labs
PPACA Right Ans - Patient Protection & Affordable Care Act - allows
sharing of IRS data to identify fraudulent providers with tax debts.
VOB Right Ans - Verification of Benefits
ROI Right Ans - Return on Investment
PECOS Right Ans - Provider Enrollment Chain Ownership System
Medicare EHHR Incentive Program Right Ans - Does Not include NP's, but
does include Dr's of MD, podiatrists, denitists, psychiatrists
VPN Right Ans - Virtual Private Network - extremely secure connections
between private networks tunneled through the internet.
,False Claims Act & Qui Tam Right Ans - Whistle Blower Act - prohibits any
person from knowingly presenting or causing false claims
Rule by All Right Ans - all physician partners are involved in decision
making
Profit Share Plan Right Ans - contributions only by employer; if offered to
employer, must be offered to employee
FMLA Right Ans - 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 Right Ans - Curretn version for HIPPA
transactions is X12 Version 5010, NCPDP Version D.0
HIPPA Breach under 500 patients Right Ans - Reports once yearly
HIPPA Breach over 500 patients Right Ans - 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* Right Ans - must notify local media and
notify Secretary of HHS
HIPPA Right Ans - applies to providers, health plans, clearinghouses,
anyone who submits any health information in an electronic manner.
Business Associates Agreement Right Ans - 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 Right Ans - requires patient notification
within 60 days of the breech
Offsite biller Right Ans - Required to log on to remote server that has
automatic logoff feature set.
, Subpoena for medical records Right Ans - You can send records requested
by court order without authorization for patient.
Employment Questions OK to ask Right Ans - 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 Right Ans - age, race, sex, religion,
national origin, disability, pregnancy
401K Right Ans - Employer & Employee Both Contribute
HR forms kept in a sperate file from employee's personnell file & in a locked
location Right Ans - OSHA Compliance
completed FMLA form
Employment eligibility forms INSS form I-9
Worker's compensation
disability forms
Income Statement Model Right Ans - This physician compensation model
requires allocation of revenue & expenses to each physician in the practice
Mid Levels Right Ans - Need Standard of Care agreement if only billing
incident to
SWOT Analysis Right Ans - Strengths, Weakness, Opportunities, Threats
Anti-Kickback Law Right Ans - can't solicit or receive payment for patient
referrals
Compliance Plan Right Ans - Includes: designated compliance officer
training & education
Written policies for denial mgmt software
Internal auditing
