CPPM Study UPDATED ACTUAL Exam
Questions and CORRECT Answers
What is the role of JCAHO? - CORRECT ANSWER operates fee based accreditation
programs to subscriber hospitals and other health care organizations
The OIG does not focus on what? - CORRECT ANSWER Training
The False Claims Act Statue : - CORRECT ANSWER makes it illegal to submit claims to
MCR /MCD bills that contain charges for services charged in excess of the usual charges
ABN's are generally used in a pediatric environment. - CORRECT ANSWER False
Carve Out Policy - CORRECT ANSWER contracted agreement between an insurance
company and another company which provides special services to its members, such as
prescription drugs or cancer treatment
What is a Medicare participating provider? - CORRECT ANSWER A provider who accepts
assignment of benefits for MCR claims
What are the the three mechanisms of payment for Medical and surgical procedures inpatient Vs.
outpatient? - CORRECT ANSWER Outpatient Surgical Services - APC reimbursed
procedures not on inpatient list only
Inpatient Surgical Services - DRG reimbursed
Freestanding ASC - Fee based
MOD - 50 or RT/LT is an example of what? - CORRECT ANSWER Carrier Specific Rules
Questions and CORRECT Answers
What is the role of JCAHO? - CORRECT ANSWER operates fee based accreditation
programs to subscriber hospitals and other health care organizations
The OIG does not focus on what? - CORRECT ANSWER Training
The False Claims Act Statue : - CORRECT ANSWER makes it illegal to submit claims to
MCR /MCD bills that contain charges for services charged in excess of the usual charges
ABN's are generally used in a pediatric environment. - CORRECT ANSWER False
Carve Out Policy - CORRECT ANSWER contracted agreement between an insurance
company and another company which provides special services to its members, such as
prescription drugs or cancer treatment
What is a Medicare participating provider? - CORRECT ANSWER A provider who accepts
assignment of benefits for MCR claims
What are the the three mechanisms of payment for Medical and surgical procedures inpatient Vs.
outpatient? - CORRECT ANSWER Outpatient Surgical Services - APC reimbursed
procedures not on inpatient list only
Inpatient Surgical Services - DRG reimbursed
Freestanding ASC - Fee based
MOD - 50 or RT/LT is an example of what? - CORRECT ANSWER Carrier Specific Rules
