CMOM Management Institute Practice
Test Questions and Answers
Why Dollars Lost? - Answer-4 main reasons why dollars get lost in practices
-Poor financial management
-Incorrect coding
-Lack of third party payer knowledge
-Lack of employee education
Collecting co-pay for divorced cases - Answer-the adult seeking treatment is
responsible for the bill. The person bringing the child is still responsible to you for
payment, the patient can bill their estranged, but not responsibility of the practice.
Contract Law* - Answer-in order to bill insurance there needs to be a SSN in place as
an identifier of the patient and to improve on identity theft.
Federal Fair Credit Billing Act - Answer-"to protect the consumer against inaccurate and
unfair credit billing"
Fee Schedule Changes to consider... - Answer-competition is a factor to consider when
making changes to a fee schedule
Embezzlement - Answer-occurs when someone fraudulently signs or alters documents,
usually checks, with change to the financial obligations of the practice.
Managed Care Accrediting Organizations - Answer--National Committee for Quality
Insurance (NCQA)
-Joint Commission on Accreditation of Healthcare (JCAHO)
-American Accreditation HealthCare Commission (AAHCC)
-Medical Quality Commission (MQC)
Preferred Provider Organization PPO
(In Network and Out of Network) - Answer-In Network: contracted providers. Patients
will have,
-Low Co-pay
-Low Deductible
-Little out-of-pocket expense
Out of Network: go outside of the contract physician list.
-High deductible
-High Co-pay
-High out-of-pocket expense
, Silent PPO - Answer-plan that has two ways to access your contracted discount fee.
behind the scenes take your info and give a less reimbursement.
Health Maintenance Organizations (HMO) - Answer-Typically have a co-pay that there
responsible for and require referral for specialists, typically every three months.
Types of HMO's - Answer-Group Model-private practice physicians, including hospitals
Network Model-contracts with one or more multi-specialty clinics
Staff Model-providers are employees of HMO and they provide services to those HMO
beneficiaries
HIPPA REGULATION: Privacy Overview - Answer-There are three major areas
addressed in the Privacy Regulation: 1. Use and disclosure of PHI, 2. Patient rights 3.
Security administrative and physical
Business Associates - Answer-can be held directly accountable by federal or state
authority for failure to comply with HIPAA statutory or regulations. ex. IT techs, Janitors,
Cleaning Services, Vendors, Collection agencies, Consultants and Billing Services.
Entities - Answer-ex. doctors, hospitals, pharmacy
Breach - Answer-unauthorized acquisition access, use or disclosure of protected health
information, ex. ALGH issue on breach where health info was spread with no consents
from patients.
What is NOT considered a breach? - Answer-1. Where an authorized person who
received the health info. cannot reasonably have been able to retain it.
2. If an unintentional acquisition, access, or use occurs within the scope of employ. and
info doesn't go any further.
3. If it is an inadvertent disclosure that occurs within a facility, and the information does
not go any further.
Tiered Increase in Civil Monetary Penalties - Answer-HIPPA violation at $50,000 per
violation and an annual maximum of $1.5million.
What are examples that could not result in HIPPA violation by DHHS? - Answer--
Overheard phone or nursing station conversation
-Joint treatment areas
-Sign-in sheets
-Calling names in reception areas
-Hospital rounds
Solutions would be to speak quietly, cubicles, curtains, dividers, asking patients to step
back, or closing doors.
Test Questions and Answers
Why Dollars Lost? - Answer-4 main reasons why dollars get lost in practices
-Poor financial management
-Incorrect coding
-Lack of third party payer knowledge
-Lack of employee education
Collecting co-pay for divorced cases - Answer-the adult seeking treatment is
responsible for the bill. The person bringing the child is still responsible to you for
payment, the patient can bill their estranged, but not responsibility of the practice.
Contract Law* - Answer-in order to bill insurance there needs to be a SSN in place as
an identifier of the patient and to improve on identity theft.
Federal Fair Credit Billing Act - Answer-"to protect the consumer against inaccurate and
unfair credit billing"
Fee Schedule Changes to consider... - Answer-competition is a factor to consider when
making changes to a fee schedule
Embezzlement - Answer-occurs when someone fraudulently signs or alters documents,
usually checks, with change to the financial obligations of the practice.
Managed Care Accrediting Organizations - Answer--National Committee for Quality
Insurance (NCQA)
-Joint Commission on Accreditation of Healthcare (JCAHO)
-American Accreditation HealthCare Commission (AAHCC)
-Medical Quality Commission (MQC)
Preferred Provider Organization PPO
(In Network and Out of Network) - Answer-In Network: contracted providers. Patients
will have,
-Low Co-pay
-Low Deductible
-Little out-of-pocket expense
Out of Network: go outside of the contract physician list.
-High deductible
-High Co-pay
-High out-of-pocket expense
, Silent PPO - Answer-plan that has two ways to access your contracted discount fee.
behind the scenes take your info and give a less reimbursement.
Health Maintenance Organizations (HMO) - Answer-Typically have a co-pay that there
responsible for and require referral for specialists, typically every three months.
Types of HMO's - Answer-Group Model-private practice physicians, including hospitals
Network Model-contracts with one or more multi-specialty clinics
Staff Model-providers are employees of HMO and they provide services to those HMO
beneficiaries
HIPPA REGULATION: Privacy Overview - Answer-There are three major areas
addressed in the Privacy Regulation: 1. Use and disclosure of PHI, 2. Patient rights 3.
Security administrative and physical
Business Associates - Answer-can be held directly accountable by federal or state
authority for failure to comply with HIPAA statutory or regulations. ex. IT techs, Janitors,
Cleaning Services, Vendors, Collection agencies, Consultants and Billing Services.
Entities - Answer-ex. doctors, hospitals, pharmacy
Breach - Answer-unauthorized acquisition access, use or disclosure of protected health
information, ex. ALGH issue on breach where health info was spread with no consents
from patients.
What is NOT considered a breach? - Answer-1. Where an authorized person who
received the health info. cannot reasonably have been able to retain it.
2. If an unintentional acquisition, access, or use occurs within the scope of employ. and
info doesn't go any further.
3. If it is an inadvertent disclosure that occurs within a facility, and the information does
not go any further.
Tiered Increase in Civil Monetary Penalties - Answer-HIPPA violation at $50,000 per
violation and an annual maximum of $1.5million.
What are examples that could not result in HIPPA violation by DHHS? - Answer--
Overheard phone or nursing station conversation
-Joint treatment areas
-Sign-in sheets
-Calling names in reception areas
-Hospital rounds
Solutions would be to speak quietly, cubicles, curtains, dividers, asking patients to step
back, or closing doors.
