CPPM CHAPTER 2 (PRINCIPLES OF
PHYSICIAN REIMBURSEMENT)
QUESTIONS AND ANSWERS 100%
CORRECT
Posting payment and collection policies in a prominent place in your office has what
benefit?
a. complies with HIPAA regulations
b. eliminates the need to file claims
c. reduces overhead by eliminating the need to verify coverage
d. prepares the patient to make proper payments at the time of service - ANSWER-d.
prepares the patient to make proper payments at the time of service
Which of the following are common billing errors?
a. Use of CPT® modifiers; no referring provider name or NPI
b. Service is not medically necessary; no referring provider name; address and ZIP
code of where service was provided
c. No ordering provider name or NPI; use of CPT® modifiers
d. No referring provider name; address and ZIP code of where service was provided;
more than one CPT code and diagnosis code - ANSWER-b. Service is not medically
necessary; no referring provider name; address and ZIP code of where service was
provided
In which of the following scenarios is Medicare the secondary payer?
a. A patient presenting for routine breast cancer screening
b. A patient who undergoes cosmetic surgery that is not covered by Medicare
c. A patient who requires surgery for a fractured hip because of a car accident
d.A patient with brain cancer who is under hospice care - ANSWER-c. A patient who
requires surgery for a fractured hip because of a car accident
Of the services listed below, which are CPT® evaluation and management services?
I. Chest X-ray
II. Allergy testing
III. Office consultation
IV. Comprehensive metabolic panel
V. New patient preventive medicine exam
a. II, III are correct
b. III, V are correct
c. I, III are correct
d. III, IV are correct - ANSWER-d. III, V are correct
, Payment for fee for service outpatient physician services is based on:
I. CPT®
II. APC
III. MS-DRG
IV. SCHIP
V. HCPCS Level II
a. II
b. III
c. I and V
d. II and IV - ANSWER-c. I and V
Which health plans below are considered public health plans?
I. Medicare
II. Medicaid
III. Health savings account (HSA)
IV. CHAMPUS/TRICARE
V. Preferred provider organization (PPO)
a. I and II
b. I, II, and V
c. I, II, and IV
d. I, II, III, IV, and V - ANSWER-c. I, II, and IV
You work for a pediatric office and the parents of a patient inform you that they can no
longer afford health insurance. They do not qualify for Medicaid as their income is too
high. What would you recommend?
a. Take the child to the emergency room when she is sick.
b. Apply for CHIP coverage
c. Seek emergency Medicaid coverage
d. Set up a payment plan for self-pay. - ANSWER-b. Apply for CHIP coverage
Which option below is NOT reported by evaluation and management codes?
a. office visits
b. nursing home visits
c. hospital visits
d. physical therapy evaluations - ANSWER-d. physical therapy evaluations
Procedure codes are reported by the provider using which code set?
a. CPT®
b. ICD-10-PCS
c. ICD-10-CM
d. SNOMED - ANSWER-a. CPT®
When reviewing denials, your biller notices that one of the private payers is not paying
for venipuncture when performed during an office visit. What should be done?
a. Check the payer contract to see if the denial is appropriate.
b. Write off the balance and note the account.
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