Exam (elaborations)
CPPM Exam Prep WITH 100- SURE ANSWERS.
- Course
- Institution
CPPM Exam Prep WITH 100- SURE ANSWERS.
[Show more]
Seller
Follow
Content preview
10/14/24, 9:13 AMCPPM Exam Prep
Jeremiah
Terms in this set (108)
Revenue Per Visit (RPV) Total amount collected divides by the total number of patient visits
Notification given to patients advising Medicare may not cover a certain procedure
Advance Benefit Notification (ABN)
or service
Payment for fee for service is based on CPT & HCPCS Level II
MCO Private Health Plan
The professional component for services provided in a facility (I.e. HOD) are less
Place of Service (POS) determines correct than when provided in a physician office as the physician doesn't have any practice
reimbursement when expense at the facility. (In private practice they pay rent, staff etc whereas is HOD
these are paid by the facility)
DEA number Is not needed for the online application to CMS for an NPI
Customer service, optimizing physician Front Desk
time and claim quality assurance are key
components to which role?
What can result in claim denial? Incorrect POS, incorrect NPI, and a truncated diagnosis code
Patients are prepared to make payments at Payment & collection policies are prominently posted in the office
the time of there visits when?
What is the most important criteria to meet Medical necessity
for the selection of Evaluation and
Management (E/M) codes?
What code set represents healthcare ICD-10.PCS
equipment, drugs and supplies?
International Classification of Diseases, Tenth Revision, Clinical Modification CM
ICD-10-CM
codes represent the diagnosis/reason a service is performed.
International Classification of Diseases, Revision Procedural Coding System. These
ICD-10-PCS
represent procedures performed at inpatient hospital facilities
current procedural terminology represent procedures performed & bilked by
CPPM Exam Prep
CPT codes
physicians and non-physicians practitioners (APP's)
1/6
, 10/14/24, 9:13 AM
for products and supplies and services not included in level I. the code is
HCPCS Level II
alphanumeric
A form that is complete and accurate and includes all provider information and other
Clean Claim Form
additional information to process for payment
History of present illness Chronological description of the development of patients complaint
Which codes are used by physicians and CPT & HCPCS Level Ii
APP's to report professional services?
Procedure codes are reported using which CPT
codes?
Medicare patient with Parts A, B & C and no Auto No-Fault
fault auto insurance is seen in the ED
following a minor auto accident, who is the
primary insurance?
What is the first thing to review when a Payer Contract to see if denial is appropriate
private payer repeatedly denies a specific
code (o.e. Venipuncture)?
Codes based on complete and accurate medical record documentation in the
Vital component of medical coding
patients chart
How often should you run a productivity Twice a year, minimally
report?
What is one purpose for a productivity To verify a good payer mix for a strong revenue stream
report?
What can add to an inefficient bad debt Numerous clinical & administrative approval requirements, unclear policies on write-
management process? off thresholds, and unclear policies that limit the amount of balance billing
A prospective method of payment. Payments are based on a physician fee schedules
Capitation payment
negotiated with the payer.
What accounts should be considered for 90+ days with a balance greater than $10
collection?
What should you consider when Address, phone #, employer, insurance verification, and co-pay collected
conducting a registration audit?
Three indicators for monitoring receivables Net collection rate, denials, and A/R days
Three components to having claims paid Procedure code, diagnosis code(s), and insurance policy number
by payer
What payments should be collected by the Any balance due that is the patients responsibility
front desk
Inclusive service as this is typically the highest dollar amount. To verify the validity,
Which denials should be a priority?
check the payers bundling edits and payer contracts.
What report and/or measurement identifies
how well a practice collects on allowable
charges
Common performance indicators for Days to enter charges, missing charges, coding accuracy
charge entry includes
The type of reimbursement used by payers to pay a predetermined set amount for
Prospective Fee Schedule
each procedure code
What tools should be considered when Balance sheet, chart of accounts and expenses from current/past year
developing a budget?
CPPM Exam Prep
2/6
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Denyss. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.99. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
77254 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now