Exam (elaborations)
CSPPM Study Guide (Certified Specialist Physician Practice Management)
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CSPPM Study Guide (Certified Specialist Physician Practice Management)
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10/14/24, 9:10 AMJeremiah
CSPPM Study Guide (Certified Specialist Physician
Terms in this set (243)
Patient treatment during a defined period. A single-date occurrence at a single
Encounter
provider
Purpose of Encounter To provide info to the insurance plan about the treatment the patient received.
* Patient & Provider demographic
Encounter report *Detailed charges and services
*Clinical information specific to the encounter
CMS 1500 form for the encounter processing
Time frame for Encounter reports to be within 72 hours
submitted?
DAR Days Accounts Receivable
Key performance indicators (KPIs) for DAR
effective claims managment
What will reduce the practice DAR? Timely submitting encounters
EDI Electronic Date Interchange
Used to have an immediate electronic EDI
receipt and provide edit and audit reports?
Customer Patient Surveys Tools to measure effective customer and patient relations
*Address directly the issues of importance to the practice
Advantage of Internal Surveys *Less expensive than an external survey
*Can monitor trends over time
*Relaying on physician and staff to come up with questions
Disadvantage of Internal Surveys *Skills sets to validate and develop questions
*Patients will not answer questions if the staff is reviewing the questions
*Professional experience to develop and validate the survey
Advantage of External Surveys
*Provides benchmark performance from other practices
Disadvantage of External Surveys *Cash out of pocket cost
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*Online patient registration by patient or staff
Methods of Pre-Registration *Mailing of new patient form
*Telephone call
Fee-for-Service Encounter paid at a contracted rate and applied to charge
*Referred specialty care
*Outside diagnostic testing services
Continuum of care
*Rehabilitation services
*Local Hospital Services
*Health Information Systems
*Medical Records Documentation
Components to manage risk
*Quality Assurance Programs
*Case Management
*Encounter documented with retail charges
Management of Third-party Receivables *Produce a claim or electronic format
*All required documentation is attached
ICD-10 Created in May 1990 by the 43rd World Health Assembly
ICD International classification of diseases
Contains about 70,000 codes ICD-10
*Probable
What diagnosis codes that can not be *Suspected
coded? *Questionable
*Ruled out
AMA American Medical Association
CPT Current Procedural Terminology
Who published the CPT? AMA (American Medical Association)
*Surgery
*Anesthesia
CPT 5 sections *Pathology
*Radiology
*E/M services
EHR Electronic health record
What is not a key component of E/M Time
services?
RBRVS Resource Based Relative Value System
Based on the principle that payments for RBRVS
physicians services should vary with the
resource cost for providing those services
and is intended to improve and stabilize
the payment system while providing
physician an avenue to improve it
*Work related value (measure of skill, training, and knowledge)
Three Components of Resource
*Physical resource or cost
Consumption:
*Cost associated with malpractice insurance
RVU Relative Value Unit
GPCI Geographic Practice Cost Index
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