Certified Physician Practice Manager (CPPM)® certification NEWVERSION 2026 AAPC EXAM PREP WITH 198 Q

Certified Physician Practice Manager (CPPM)® certification NEWVERSION 2026 AAPC EXAM PREP WITH 198 QUESTION AND ANSWERS Correct Incorrect

Your answers

1 of 198 Term

What are fixed expenses?

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Salaries, Rent, Malpractice

Net Income

New Taxes, New Health Industry Deposit Slips From The Bankd

Fees, Cuts In Existing Government Health Programs

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2 of 198 Term

The OIG recommend physicians focus on four basic risk areas. What is not a recommendation?

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Age

Bundling?

Exposure Control Plan

Hot Site

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3 of 198 Term

Which MIPS component is designed to improve clinical practice or care delivery leading to improved outcomes?

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Improvement Activities

Public Health Reporting

Readmission Rates

Quality Of Care

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4 of 198 Term

What is considered accounts payable?

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Refunds due to patients for over payments on their account

Salaries owed to employees for the month

Payments received from insurance companies

Invoices sent to patients for services rendered

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5 of 198 Term

One of the specialists walks into your office without knocking, sits down in the chair across from you, leans forward and begins berating you for the way you handled a recent office situation. What body language would you use to show you are listening and ready to discuss his complaint?

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Stay seated and lean forward

Be quiet and listen to all his concerns

Suspend services temporarily.

Listen

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6 of 198 Term

What is covered by Medicare Part b?

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Physician Services

Hospital Services

Occupational Therapy Services

Prescription Drugs

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7 of 198 Term

What is not reported by evaluation nd management codes?

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Diagnostic imaging procedures are reported for radiology visits.

Laboratory tests are reported for routine blood work.

Surgical procedures are reported for outpatient surgeries.

Physical therapy evaluations = E/M services are reported for visits made by physicians or other qualified healthcare providers in the office, hospital, and nursing home.

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8 of 198 Term

What type of disaster recovery is less expensive for a provider?

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Hot Site

Cold Site

Warm Site

White Site

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9 of 198 Definition

A quality cycle and QI method that systematically impacts a process or system

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Which of the following is a trend in health care that can be expected with health care reform?

Staff accountability is best achieved by:

Plan-Do-Check-Act is defined as

What is considered a Business Associate (BA)?

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10 of 198 Term

You selected an EMR for your office and are ready to begin implementation. What is the first step in this process?

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Select a vendor for ongoing maintenance

Identify a steering committee to oversee the process

Create a timeline for staff training

Develop a detailed budget for the project Don't know?

11 of 198 Term

What type of reimbursement methodology is based on the average resources required to care for an inpatient with a specific diagnosis?

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MS-DRGs

Ap-drgs

Apr-drgs

Cpt-drgs

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12 of 198 Term

When reviewing the communication process of an EMR, which would reflect a good plan?

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Messaging sent to a provider regarding a patient should

Messaging sent to a provider should be attached to the provider's

have the ability to attach to the patients chart.

personal file.

Messaging sent to a provider

Messaging sent to a provider should be deleted after review.

should be stored separately from the patient's chart.

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13 of 198 Term

When reviewing denials, your biller notices that one fo the private payers is not paying for venipuncture when performed during an office visit. What should be done?

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Remove venipuncture from the list of services provided

Adjust the billing software to automatically approve venipuncture

Contact the payer to dispute the policy

Check the payer contract to see if the denial is appropriate

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14 of 198 Term

What is the best way to handle a verbal attack?

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Explain

Listen

Breathe

Watch

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15 of 198 Term

Which is an example of a practice monitoring quality assurance?

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External audit of patient satisfaction surveys

Internal audit of billing procedures to verify compliance with federal and state regulations

Assessment of staff training programs for customer service

Review of marketing strategies to attract new patients

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16 of 198 Term

Who oversees the Health IT certification program for EHRS and Health Information Exchanges?

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American Medical Association

Office of the National Coordinator for Health Information technology

Centers for Disease Control and Prevention

National Institute of Health

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17 of 198 Term

Ex[ansion of medicaid and insurance mandates will have the following affect:

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Reduce the roles and scope of services for non physician providers

Expand the roles and scope of services for non physician providers

Shift focus to physician-only services

Limit the responsibilities of non physician providers

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18 of 198 Term

What are common billing errors?

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Service was not medically necessary, No provider name, address and zip code of where service was provided.

Unauthorized service, Incorrect billing address, Omission of treatment plan details

Incorrect patient demographics, Missing insurance information, Incomplete medical history

Service was provided by a specialist, No date of service, Misinterpretation of medical records

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19 of 198

Term

What are examples of operational workflows?

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Procedure for staff meetings, inventory ordering, vendor management

Process for checking in, scheduling, services provided

Protocol for facility maintenance, budget allocation, customer feedback

Process for employee evaluations, financial audits, marketing campaigns

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20 of 198 Term

When and where are the measures used for the MIPS quality component published?

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March 1 of each year in the state health bulletin

June 1 of each year in the medical association newsletter

November 1 of each year in the federal register

January 1 of each year on the CMS website

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21 of 198 Term

What financial statement is used to maintain awareness of the fund available to support ongoing business operations in your practice?

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Accounts Receivable Statement

Retained Earnings Statement

Accounts Payable Statement

Cash Flow Statement

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22 of 198 Term

The congressional budget office estimates health care reforms will cost an estimate $940 billion over the next 10 years, which will be paid for primarily through

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Increased government subsidies, Reduced administrative costs, Enhanced private insurance plans

New Taxes, New Health industry fees, Cuts in existing government health programs

Additional federal grants, Streamlining of healthcare regulations, Cuts in hospital funding

Higher premiums for consumers, Expansion of public health programs, Decrease in pharmaceutical research

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23 of 198 Term

Sound office systems decrease likelihood of:

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Age

Libel

Invasion Of Privacy

Malpractice

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24 of 198 Term

What is an advantage of leasing equipment?

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Lease payments are deductible for income tax purposes

Lease agreements do not require credit checks

Lease payments are not deductible

Leasing avoids depreciation costs

for tax purposes

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25 of 198 Term

When a practice sees revenue fluctuating, the factors most often at the heart of the decreases are:

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Equipment malfunctions, marketing failures, competitor actions, regulatory changes

Patient Volume, Staff delays and errors, coding delays and errors, billing delays and errors, insurance delays.

Economic downturns, seasonal variations, vendor price increases, technology updates

Staff turnover, facility upgrades, inventory shortages, patient satisfaction issues Don't know?

26 of 198 Term

Which of these methods is not recommended for collecting payment from insurance payers?

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Provide a discount if payment

Provide an extended payment plan

Offer a bonus for early payment

is received by a certain date.

Waive late fees if paid within a week

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27 of 198 Term

What is the main similarity between quality assurance and quality improvement?

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Improved Patient Satisfaction

Participation in a GPO

Provide services based on scientific knowledge

Address work flow

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28 of 198 Term

OSHA has specific requirements for BBP Exposure Control plan.

What is not required?

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Hazard Class Or Division Number

Manufacture Date

Emergency Contact Number

United Nations Identification Number

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29 of 198 Term

Which does not represent the effective use of a budget?

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To monitor the debt to equity ratio of a clinic - it is important to monitor but not part of the budget process.

To track the daily revenue fluctuations of a clinic

To analyze the patient satisfaction ratings

To monitor the staff turnover rates

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30 of 198 Term

Which is appropriate under EMTALA?

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Patient presents to emergency dept. with a cold. After assessment, patient is admitted for observation.

Patient presents to emergency dept. with a cold. After quick assessment it is determined patient can be treated at the outpatient clinic.

Patient presents to emergency dept. with a chronic condition. After assessment, patient is referred to a specialist immediately.

Patient presents to emergency dept. with a minor injury. After evaluation, patient is discharged without treatment.

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31 of 198 Term

What does administrative Simplification include?

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Billing procedures, patient scheduling, medical coding, staff training

Privacy rule, code sets, security rule, electronic transactions, identifiers

Clinical protocols, medical records management, patient feedback

Financial reporting, equipment maintenance, marketing strategies

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32 of 198 Term

Which statement best describes an effective marketing plan?

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Limiting access to the medical records to only those employees who need it for a specific purpose.

Creating a service that is of interest to patients and then effectively communicating these services to them

Accurately coded encounters, completed medical records, identifying when a claim is not paid

Messaging sent to a provider regarding a patient should have the ability to attach to the patients

promply

chart.

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33 of 198 Term

Electronic health records guide a provider to select E/M codes based on the number of elements documented. What does this leave out that causes a potential compliance risk?

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Age

Predetermination Findings

Medical Necessity

Covered Services

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34 of 198 Term

Which option would be the best policy for the back-up of your practice management and MER systems?

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Back-up the systems daily and store the back-up tape in a fireproof cabinet.

Back-up the systems weekly and store the back-up tape on-site.

Back-up the systems daily and store the back-up tape offsite.

Back-up the systems monthly and store the back-up tape in a cloud storage.

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35 of 198 Term

In which kind of a scenario is Medicare the secondary payer?

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A patient who seeks chiropractic treatment for back pain - Medicaid becomes primary payer.

A patient who requires physical therapy after a sports injury private insurance becomes primary payer.

A patient who requires surgery for a fracture hip as a result of a car accident - auto insurance becomes primary payer.

A patient who needs routine dental care - Medicare Advantage becomes primary payer.

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36 of 198

Term

As a new manager, you oversee implementing a marketing plan.

When you would implement it?

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Once market trends are fully analyzed

After you have the right people and good processes/systems in place

Before securing funding and resources

After evaluating competitor strategies

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37 of 198 Term

A database that compiles a patients data from a variety of clinical sources to present a unified view of a singe patient is called:

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Lab Equipment Calibration

Planned Redundancies

Clinical Data Repositroy

Structured Data

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38 of 198 Term

In which of the following scenarios would it generally be preferable to purchase equipment instead of leasing it?

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A clinic that seeks tax benefits from leasing agreements

A clinic that prefers short-term equipment use and minimal maintenance

A clinic that has a strong bank account and plans on using the equipment for a long period of time.

A clinic with limited funds and variable equipment needs

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39 of 198 Term

Four main categories of risk

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Professional, personal, property, financial

Safety, appearance, atmosphere

Preventative, detective, and corrective

Patient, Physician, Coder, Fraud Auditor, Compliance Officer Don't know?

40 of 198 Term

What are the primary objective of the Affordable Care Act?

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1. Expanding Health Coverage, 2. Controlling Healthcare Costs, 3. Modernizing the healthcare delivery system

Messaging sent to a provider regarding a patient should have the ability to attach to the patients chart.

Measure the net collection rate, monitor denials, measure the A/R days

To monitor the debt to equity ratio of a clinic - it is important to monitor but not part of the budget process.

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41 of 198 Term

What is part of the MIPS promoting Interoperability measures using 2015 CEHRT?

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System Updates, Data Encryption, Staff Training

Data Backup, Patient Surveys, Clinical Documentation

Security Risk Analyus, EPrescribing, Providing Patient access, Send a summary of care, Request, Accept Summary of Care

Network Security, Data Migration, User Permissions

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42 of 198 Term

What are three key indicators in monitoring receivables?

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Measure the net collection rate, monitor denials, measure

Analyze marketing ROI, monitor patient retention, measure billing

the A/R days

cycle time

Track patient satisfaction, monitor referral rates, measure invoice accuracy

Assess staff productivity, monitor appointment scheduling, measure patient wait time

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43 of 198

Term

What are reasons physicians are integrating relationships with other providers/facilities?

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Conversions to EMR, Health Care Reform, and declining reimbursement

Standardization of medical equipment, Streamlining of patient scheduling, Enhancement of clinical research

Simplification of billing processes,

Expansion of patient networks,

Improvement in patient satisfaction, Growth in marketing opportunities

Increase in administrative tasks, Rise in insurance premiums

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44 of 198 Term

What is NOT a step involved in a risk investigation?

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Align with the organizations strategic goals

Consider new ancillary services in the clinic

Increase traffic with search engine optimization

Evaluate capital lossess

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45 of 198 Term

Which option below would be the most effective interview question about employee conflict resolution?

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In the past, when in conflict with another employee, how was the conflict resolved?

How do you typically avoid conflicts with coworkers?

Describe a time when you initiated a conflict with another employee.

What steps do you take to ensure no conflicts arise in the workplace?

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46 of 198 Term

The most common language used to communicate between internal applications and other facilities is called

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HL7

XML

JSON

EDI

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47 of 198 Term

When reviewing an income statement, what is the term that refers to the profit the practice made over a specific time period?

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Net Income

Gross Profit

Gross Revenue

Gross Income

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48 of 198 Term

The Place of Service (POS) code on a claim form is important to determine correct reimbursement. Which statement is correct?

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Allows insurance to increase rates based on pre-exisiting conditions.

This is a major change. I'll do my best to show you how it works.

The professional component for services provided in a facility (for example, hospital or ASC) are less than when provided in the physicians office because the physician does not have any practice expense at the facility like rent, staff, and supplies.

Yes, business associates are required by HIPAA and by their BAA agreement to protect PHI

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49 of 198 Term

A patient is returning today for her second injection of denosumab for postmenopausal osteoporosis. To achieve the best staff efficiency which of the following staff members should perform the injection?

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Medical Assistant

Pharmacy Technician

Registered Nurse

Nurse Practitioner

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50 of 198 Term

Which list best represent what is included in business continuity and disaster recovery panning?

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Staff-patient communications, where staff and patients will

Patient billing procedures, staff training schedules, inventory management

Financial planning, marketing strategies, equipment maintenance

go, fire exits and how staff will continue to do their job.

Facility expansion plans, vendor contracts, patient satisfaction surveys

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51 of 198 Term

What individuals can file a qui tam suit?

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Patient, Physician, Coder, Fraud Auditor, Compliance Officer

Medical Technician, Therapist, Laboratory Technician, Billing Specialist

Insurance Agent, Pharmacist, Hospital Administrator, Nurse Practitioner

Dentist, Chiropractor, Physical Therapist, Medical Assistant

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52 of 198 Term

What do you need to ensure patient safety in the event of a disaster?

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Create a new business model,

Implement new technology,

reorganize office layout, improve patient communication

streamline administrative tasks, enhance marketing strategies

Plan business continuity, a management plan, recovery resources to safeguard operations and ensure patient safety.

Develop staff training programs, update financial records, expand service offerings

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53 of 198

Term

What is true regarding the billing office workflow?

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Financial stability is unaffected by

Billing office workflow has no

billing office procedures.

impact on financial security.

Cash flow and financial security can fluctuate based on the workflow of the billing office

Cash flow is solely determined by patient volume.

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54 of 198 Term

When should the staff obtain a photocopy of the patients insurance card?

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When the patient is discharged from the hospital

When the patient schedules their appointment

When the patient arrives for their appointment

After the patient completes their visit

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55 of 198 Term

What is an Alternative Payment Model (APM)?

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Risk-bearing contracts that require a provider to put up more than a nominal financial risk.

Agreements that focus solely on administrative efficiency

Arrangements where providers receive bonuses for reducing patient volume

Contracts that guarantee fixed payments to providers regardless of outcomes

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56 of 198 Term

Which MIPS component is calculated based on Medicare Spending per Beneficiary, total per capita costs, and condition and treatment episode-based measures?

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Quality

Cost

Availability

Time

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57 of 198 Term

What are examples of services included in interoperability of electronic date in the ambulatory setting.

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Electronic Health Records, Clinical Trials, Medical Research, Patient

Administrative Tasks, Staff Training, Compliance Reporting, Data

Surveys

Analytics

DME, Lab Test, Referrals to other providers, Medications

Patient Scheduling, Billing, Medical Coding, Insurance Claims Don't know?

58 of 198 Term

Good patient exsperience?

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Safety, appearance, atmosphere

Minimal waiting time, appearance, safety

Personal, Financial, Property, Professional

Age

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59 of 198 Term

What determines the profitability of a new piece of equipment or service?

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Gross Profit Margin

Break Even Analysis

Vertical Analysis

Appointment Scheduling

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60 of 198 Term

MIPS data for advancing care information is based on the CEHRT edition used. Which editions were available as options?

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2012 & 2013

2014 & 2015

2010 & 2011

2016 & 2017

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61 of 198 Term

Your office recently installed a new phone system. Training was provided to the staff and the physicians. One of the physicians can't seem to get the hang of it and is continually disconnecting his calls.

He calls you into his office and blames you for the faulty phone system and his inability to learn how to use it. Using good communications skills, you would"

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Be quiet and listen to all his concerns

Apply for CHIP coverage

Give advice that is not asked for

Let the person know, "I understand how you feel."

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62 of 198 Term

Which of the following options would be the most beneficial in managing costs?

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Improvement Activities

Deposit Slips from the Bankd

Appointment Scheduling

Participation in a GPO

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63 of 198 Term

How do you calculate equity?

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Equity = Assets-liabilities

Net Income

Cost

Break Even Analysis

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64 of 198 Term

Included in the business workflow are activities that verify

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Accurately coded encounters, completed medical records, identifying when a claim is not paid promply

Properly filed invoices, completed staff evaluations, identifying when a claim is delayed due to administrative issues

Correctly processed billing codes, updated patient demographics,

Accurately documented patient feedback, updated insurance

identifying when a claim is rejected due to provider error

policies, identifying when a claim is denied due to patient error

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65 of 198 Term

You are tasked with hiring an employee with inpatient coding experience. Which code set will they need to understand for inpatient procedures?

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ICD-10-CM

CPT-HCPCS

ICD-10-PCS

SNOMED CT

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66 of 198 Term

What act is part of the ARRA and includes an incentive payment program?

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PPACA

HITECH

HIPAA

ADA

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67 of 198 Term

Which of the following is an example of how IT can help reduce medical errors?

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Electronic billing for insurance claims

Digital tracking of patient satisfaction scores

Computerized order entry for radiology tests

Automated scheduling for patient appointments

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68 of 198 Term

What types of stored data can be used for electronic querying and reporting?

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Unstructured Data

Distributed Database

Big Data

Structured Data

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69 of 198 Term

What can you legally ask about in an interview

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Patient, Physician, Coder, Fraud Auditor, Compliance Officer

Age, Marital status, Religious beliefs, Ethnic background

Citizen of the US, Convicted of a crime, Education level, Worked under different name

Race, Political affiliation, Personal interests, Family history

- No age, race, ethnicity, religion, disability

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70 of 198 Term

Which would be elements of a PDCA (Plan-Do-Check-Act) cycle?

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Creating a service that is of interest to patients and then effectively communicating these services to them

Internal audit of billing procedures to verify compliance with federal and state regulations

A quality cycle and quality improvement method, requires a benchmark so the team understands the goal for improvement, review the original benchmark data to determine if improvements are made

Your income statement will not reflect true cash for the defined period

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71 of 198 Term

Which services meet medical necessity?

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Cosmetic surgery for aesthetic improvement

An elective procedure for minor discomfort relief

A routine check-up for a healthy adult

A lipid panel for a patient with high cholesterol

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72 of 198 Term

A billing office, has used EOBS in an educational setting. Is this a violation of HIPAA?

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Conversions to EMR, Health Care Reform, and declining reimbursement

Yes, business associates are required by HIPAA and by their BAA agreement to protect PHI

New Taxes, New Health industry fees, Cuts in existing government health programs

Provide new and innovative ways for providers to expand offerings to patients.

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73 of 198 Term

The practice currently scanning insurance cards for every visit.

Practice it running out of storage space on the server. What is the best solution?

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Eliminate scanning insurance cards altogether and rely on verbal information

Require the front desk to scan all documents twice for backup

Require the front desk to verify the copy in the EMR and only scan if something has changed with patients insurance/

Automate the process to scan insurance cards directly into the cloud storage

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74 of 198 Term

Clinical decision support (CDS) MAY BE USED BY PROVIDERS TO HELP PREVEN ERRORS AND HEALTHCARE EFFICIENCY. At what point of a patient visit would the CDS be most helpful to the provider?

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Review Of Symptoms

Chief Complaint

Physical Exam

Medical Decision Making

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75 of 198

Term

Payment for fee for service outpatient physician services is based on?

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CPT and ICD-9

ICD-10 and HCPCS Level I

CPT and HCPCS Level II

ICD-10 and CPT Level III

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76 of 198 Term

As part of the initial cost control, there is a focus on fraud and abuse reform by HHS, OIG, FBI, Medicare and Medicaid and DOJ. Which of the following is included in the fraud and abuse provision?

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Procedure codes, diagnosis codes, and insurance policy number

The provider is in an APM (Advanced Payment Model) or bills more than $30,000 in Part B allowable charges and sees more than 100 Medicare patient sin a year

Providers are required to supply, upon request, documentation of DME and home health referrals.

Notification to patient That Medicare may not cover a certain procedure or service

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77 of 198 Term

The advances in technology have helped integrate day-to-day operations of the medical office. Which does not demonstrate technology improvements?

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Improved Patient Satisfaction

Improved Coding

Improved Efficiency

Increased Costs

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78 of 198 Term

Waste can be described as

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Overuse of services

Poor compliance

Diversity of Staff

Higher prices

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79 of 198 Term

When looking where to cut costs, which financial statement is most useful?

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Cash Flow Statement

Balance Sheet

Income Statement

Retained Earnings Statement

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80 of 198 Term

What is the best description of an office manager?

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Focuses on strategic planning and long-term goals without managing daily tasks.

Concentrates on administrative tasks and avoids managing others.

Handles financial planning and budgeting without overseeing staff activities.

Focuses on tactical activités and often have amore directive and controlling appeal AND manages the activities of others.

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81 of 198 Term

What does a good compensation plan include?

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A pay scale that takes into consideration the industry standards and adjusts for years of service, special

A commission-based plan that rewards sales performance only

training and other benefits.

An hourly wage that adjusts for inflation and market trends

A fixed salary with annual bonuses based on company profits

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82 of 198 Term

Which of the following is an example of cash based accounting?

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In order to prepare to offer botox in September, the practice purchases the supply in august and reports the expense in August.

The practice records the expense in September when the service is provided

The practice delays reporting the expense until the following month

The practice amortizes the expense over several months

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83 of 198 Term

Procedure codes are reported by the provider using which code set?

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HCPCS codes represent medical equipment and supplies

CPT codes represent procedure performed and billed by physicians and nonphysician practitioners

NDC codes represent

ICD codes represent diagnoses and conditions

pharmaceutical products

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84 of 198 Term

Posting payment and collection policies in a prominent place in your office has what benefit?

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Prepares the patient to make proper payments at the time of service.

Simplifies the billing process for insurance companies.

Guarantees patient satisfaction with service quality.

Ensures patients receive immediate medical attention.

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85 of 198 Term

Which health plans are considered public health plans?

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RVU, GPCI, CF

Medicare, Medicaid, CHAMPUS/TRICARE

ICD-10-PCS - Inpatient Hospital Facilities. Only Submitted By FACILITIES!

CPT And HCPCS Level II

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86 of 198 Term

How can you increase exposure on insurance plans?

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Make sure your practice information is listed in insurance directories.

Create partnerships with pharmaceutical companies.

Focus on internal staff training only.

Advertise services through local newspapers.

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87 of 198 Term

Billing remotely from home. What would be a reasonable safeguard?

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Allow the employee to access data through a public Wi-Fi network

Require the employee to use a generic password for all systems

Require the employee to log on to a remote server that has an automatic logoff feature set.

Provide the employee with a personal laptop for home use

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88 of 198 Term

When determining the scanning equipment process, which statement is best to keep in mind?

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Cheaper scanners are sufficient for basic tasks and save money

Manual scanning is faster for small volumes of records

Older scanners are more reliable for long-term use

Better scanners cost more money, but will usually pay for themselves in time spent quickly when converting large volumes of paper records to electronic files.

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89 of 198 Term

Which of the following is the best example of quality control?

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Computerized order entry for radiology tests

Patient preparation

Lab equipment calibration

MGMA surveys

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90 of 198 Term

Which of the following provision of the PPACA will help reduce fraud and abuse"?

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Allows insurance to increase rates based on pre-exisiting conditions.

Providers are required to supply, upon request, documentation of DME and home health referrals.

Allows sharing of IRS data to identify fraudulent providers or providers with tax debts

Your income statement will not reflect true cash for the defined period

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91 of 198 Term

HEI is the exchange of data (PHI_ between organizations. Types of organizations receiving PHI are

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Government Agencies, Research

Hospitals, Patient Portals,

Institutions, Educational Facilities

Public Health

Pharmaceutical Companies, Dental Offices, Veterinary Clinics

Insurance Companies, Pharmacies, Medical Device Manufacturers

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92 of 198 Term

Which statement is true regarding accrual-based accounting?

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Your income statement will not reflect true cash for the defined period

Your balance sheet will show exact cash reserves for the period

Your cash flow statement will match the income statement exactly

Your income statement will accurately reflect all cash transactions

Don't know?

93 of 198 Term

Medicare offers plans for Part A, Part B, Part C, and Part D. Which of these covers inpatient hospital care?

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Part A

Structured Data

Net Income

Malpractice

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94 of 198 Term

What type of scheduling allows for patients to be seen in order upon arrival?

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Rotation scheduling

Block scheduling

Mixed scheduling

Wave scheduling

Don't know?

95 of 198 Term

Where do you start with marketing?

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Design new business cards

Develop a detailed budget plan

Verify good systems, right people and culture, provides quality services

Create a social media calendar

Don't know?

96 of 198 Term

Which of the following is the best example of communicating in a difficult conversation?

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Let the person know, "I understand how you feel."

Let the person know, "I don't agree with your feelings."

Let the person know, "I can't relate to how you feel."

Let the person know, "You're overreacting."

Don't know?

97 of 198 Term

Which benefits has federal regulations that directly tie the physicians benefit to employees benefit

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Stark And Anti-Kickback

Diversity Of Staff

Profit Share Plan

Planned Redundancies

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98 of 198 Term

When performing a registration audit, what should you look at?

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Demographic changes, family history, emergency contacts, Consent forms

Address, phone numbers, employer, insurance verification, Copay collected.

Medical history, medication list, lab

Billing history, payment methods,

results, Appointment history

referral sources, Medical records

why?

Correct answer Yes/No questions fo verify date and other objective information. OpenEnded questions to evaluate how an employee would respond to particular situations

101 of 198 Term

What would be considered a violation under the false claims act?

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Correct answer Submitting a claim with unbundled services that can be bundled, falsifying a medical record to support payment of a claim in an audit.

102 of 198 Term

How can you lower costs?

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Skipped

Correct answer Request different quotes from different vendors

103 of 198 Term

Quality Care improvement includes which of the following?

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Skipped

Correct answer Provide services based on scientific knowledge

104 of 198 Term

Which is most effective for increasing revenue streams in the practice?

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Skipped

Correct answer Consider new ancillary services in the clinic

105 of 198 Term

Which statement is true regarding prior authorizations?

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Correct answer Someone who can effectively communicate clinical significance to the payer should obtain the prior authorization.

106 of 198 Term

What is a way to increase website visibility?

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Skipped

Correct answer Increase traffic with search engine optimization

107 of 198 Term

What is an important piece of the revenue cycle?

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Skipped

Correct answer

Appointment Scheduling

108 of 198 Term

An ABN form is used to:

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Skipped

Correct answer Notification to patient That Medicare may not cover a certain procedure or service

109 of 198 Term

Which is an effective response when a provider is complaining about how hard it is to use the new EMR system the owners of the practice selected?

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Skipped

Correct answer This is a major change. I'll do my best to show you how it works.

110 of 198 Term

What should bank deposit be balanced against?

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Skipped

Correct answer Deposit slips from the bankd

111 of 198 Term

Four main categories of a risk management plan?

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Correct answer Personal, Financial, Property, Professional

112 of 198 Term

What type of measures would be included in disaster recovery planning?

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Correct answer Preventative, detective, and corrective

113 of 198 Term

Staff accountability is best achieved by:

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Correct answer Assigning object goals; assigning measurable goals; define the responsibility for tasks.

114 of 198 Term

Quality improvement focuses on

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Skipped

Correct answer Refining process to reach higher levels of quality

115 of 198 Term

Which of the following best describes when accounts should be sent to a collections agency?

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Skipped

Correct answer Any patient account over 90 days old with a balance over $10.

116 of 198 Term

What is an ACO?

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Correct answer

Accountable Care Organizations (ACO). A group of doctors and hospital who, as a team, agree to be responsible for a patients overall care.

117 of 198 Term

Hospitals bill for inpatient services based on

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Skipped

Correct answer MS-DRG

118 of 198 Term

What is a benefit of an ERA (Electronic remittance advice)?

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Correct answer Save staff time and reduce data entry errors

119 of 198 Term

You work for. a pediatric office and the parents of a patient inform you they can No longer afford halter insurance. They do not qualify for Medicaid as their income is too high. What would you recommend?

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Skipped

Correct answer Apply for CHIP coverage

120 of 198 Term

A timely filing deadline is

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Correct answer An amount of time stipulated by the insurance carrier contract to file a clean claim

121 of 198 Term

The ACA health legislation enacts several provisions on insurance companies that are aimed at improving customer safeguards. Which provision is NOT included in the health reform?

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Skipped

Correct answer Allows insurance to increase rates based on pre-exisiting conditions.

122 of 198

Term

Which statement is TRUE regarding program interacting?

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Skipped

Correct answer Interfacing is necessary to reduce duplicate entries of demographic information

123 of 198 Term

Which is an example of a private Health Plan?

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Skipped

Correct answer MCO

124 of 198 Term

Employees can make a difference in the appearance of the office by:

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Skipped

Correct answer Picking up garbage and straightening chairs, wipe smudges from windows.

125 of 198 Term

What has communication of electronic data been so difficult in the past?

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Skipped

Correct answer Each system was using different technical vocabularies making it difficult to communicate between systems.

126 of 198 Term

What are three component that are necessary to have a claim paid correctly by the payer?

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Skipped

Correct answer Procedure codes, diagnosis codes, and insurance policy number

127 of 198 Term

Which option would not be included in a post-disaster checklist?

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Skipped

Correct answer Remove unsalvageable equipment immediately - wait for adjuster!

128 of 198 Term

There are many elements to a successful appeals process. What is the first and most important process?

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Skipped

Correct answer Analyze the reason for the denial.

129 of 198 Term

Why was HIPAA enacts?

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Skipped

Correct answer To simplify the administration of health insurance

130 of 198 Term

What is an SEo and why is it useful?

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Correct answer Search engine Optimization, increases traffic

131 of 198

Term

A claim form that is complete and accurate and includes all provider information, member information and other additional information needed to process for payment is called?

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Skipped

Correct answer A clean Claim

132 of 198 Term

Following a disaster a ______________ allows for a practice to be up and running in a matter of hours if not less. This ais a place that mirrors the original.

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Skipped

Correct answer Hot Site

133 of 198 Term

When conducting a salvage operation, what should be done with damaged equipment?

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Skipped

Correct answer Leave it on site until seen by an insurance adjuster

134 of 198 Term

Which of the following is a road-block to active listening?

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Skipped

Correct answer Give advice that is not asked for

135 of 198 Term

What is the most important criteria to meet for the selection of Evaluation and management codes?

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Skipped

Correct answer Medical Necessity

136 of 198 Term

Which providers may write prescriptions?

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Skipped

Correct answer Physician's Assistant; Nurse Practitioner

137 of 198 Term

A well-managed scheduling workflow process has advantages. What would not be an advantage?

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Skipped

Correct answer Employee satisfaction

138 of 198 Term

What instances below can add to an inefficient bad debt management process?

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Skipped

Correct answer Numerous clinical and administrative approval requirements, unclear policies on write off thresholds, unclear policies that limit the amount of balance billing

139 of 198 Term

Medicare uses RBRVS to determine reimbursement rates. What are the three factors used to calculate a rate for each CPT?

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Skipped

Correct answer RVU, GPCI, CF

140 of 198

Term

Claim denials or delays can Be caused by inaccurate data. What type of denials should the practice management look for that indicate a potential training need for data entry?

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Skipped

Correct answer Information gathered at the time of registration is paramount for clean claims submission, authorizations for services, and future collection efforts.

141 of 198 Term

When reviewing payer contracts, how is the RPV (Revenue Per Visit) Calculated?

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Correct answer

Total amount collected divided by the total number of patient visits.

142 of 198 Term

Leadership and management have different characteristics. What is more representative of a leader?

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Skipped

Correct answer Inspire and motivate employees.

143 of 198 Term

Which of the following is a trend in health care that can be expected with health care reform?

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Skipped

Correct answer The focus of care will shift from acute care to preventative care and wellness

144 of 198 Term

When should credentialing of a provider be performed?

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Skipped

Correct answer When it is determined the physician will be hired

145 of 198 Term

Where can you find external benchmarks for concurrent medical practices?

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Skipped

Correct answer MGMA surveys

146 of 198 Term

When developing a physician compensation plan, the main consideration should

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Skipped

Correct answer Align with the organizations strategic goals

147 of 198

Term

which physician compensation model requires allocation of revenue and expenses to each physician in the practice?

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Skipped

Correct answer Income Statement model

148 of 198 Term

It is anticipated that expansion of medicaid and mandated insurance coverage will add millions of newly insured Americans. In order to meet the demand of these patients, it is anticipated

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Skipped

Correct answer

An increase in the use of midlevel providers

149 of 198 Term

An established patient did not keep her scheduled appointment.

There is or record that she called to cancel or reschedule. This is her third "No show" in one year. Based on the No-show policy, which of the following process should be followed?

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Skipped

Correct answer Suspend services temporarily.

150 of 198 Term

What has been implemented through HIPAA Laws

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Skipped

Correct answer Privacy, security, transactions and code sets, provider identifiers

151 of 198 Term

What should be used on smart phones to ensure patient data is protected?

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Skipped

Correct answer Device level and application level authenitcation

152 of 198 Definition

Ask: Is this a good time to talk?; Prepare a short statement in advance that gets right to the point, Empathize with the person, Sympathize with the person.

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Skipped

Correct answer Which are good options when initiating a difficult conversation?

153 of 198 Term

Which are CPT evaluation and management services?

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Skipped

Correct answer Office consultation and New Patient Preventive Medicine Exam

154 of 198 Term

Which of the following services would bet the most profitable and efficient use of mid-level provider in a. physician's office and meets incident-to rules?

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Skipped

Correct answer Sees established patient for follow-up visits of established conditions.

155 of 198 Term

Which is a common reason for denials?

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Skipped

Correct answer The service is not medically necessary.

156 of 198 Term

What is important for good purchasing?

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Skipped

Correct answer Identify what supplies and equipment are needed to provide the necessary services for your clinic

157 of 198 Term

Which cannot be used to base firing or hiring of an employee?

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Skipped

Correct answer

Age

158 of 198 Term

Which of the following would be a best practice for a new patient to your office?

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Skipped

Correct answer Gather as much information as possible prior to the visit

159 of 198 Term

In the context of precautionary measures, what is a system of mirrors?

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Skipped

Correct answer Planned Redundancies

160 of 198 Term

How do you provide an auditor access from home?

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Skipped

Correct answer Authentiation and digital signatures

161 of 198 Term

Each physician wants their own office in the newly designed space...

What is your advice?

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Skipped

Correct answer Tell the physicians it is not the most efficient use of space

162 of 198 Term

What are some financial implications of implementing an EMR system?

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Skipped

Correct answer Purchase of software, Training staff, Upgrade Costs, Ongoing support

163 of 198 Term

A patient has filed a workers comp claim. The employer request the medical records. Can the provider send the medical records without authorization from the patient? `

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Skipped

Correct answer YES - If the employee is a member of the workplace, and it is concerning a workplace injury, the records can be released.

164 of 198 Term

The security rule requires passwords. What is the most secure?

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Skipped

Correct answer Pas$132

165 of 198 Term

The difference between efficiency and effectiveness is:

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Correct answer Efficiency is doing things right while effectiveness is doing the right things.

166 of 198 Term

Which option is NOT a goal of the Medicare Access and CHIP reauthorization Act of 2015 (MACRA)?

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Skipped

Correct answer

Provide new and innovative ways for providers to expand offerings to patients.

167 of 198 Term

What payments should be collected by the front desk?

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Skipped

Correct answer Any payment the patient is responsible for

168 of 198 Term

President Obama signed into law the comprehensive health reform legislation known as:

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Skipped

Correct answer Patient Protection and Affordable Care Act

169 of 198 Term

What is considered a Business Associate (BA)?

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Skipped

Correct answer Billing companies, Software vendors, Consultants, transcriptionists

170 of 198 Term

Which statement is TRUE regarding fraud and abuse provisions of the PPACA?

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Skipped

Correct answer Providers are required to supply, upon request, documentation of DME and home health referrals.

171 of 198 Term

What would be an effective way to manage drug samples within an office?

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Skipped

Correct answer Keep a drug sample closet that is locked and requires documentation of samples provided to patients.

172 of 198

Term

Which is a vital component to proper medical coding?

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Correct answer Codes based on complete and accurate medical record documentation in the patients chart

173 of 198 Term

Which of the following are benefits of using a mid-level provider?

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Correct answer

Improved revenue; improved patient satisfactions; greater access to care for patients.

174 of 198 Term

What do you do with hard copies of old chart when you switch to a new EMR?

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Skipped

Correct answer Move them in off-site storage

175 of 198 Term

In order to minimize risk, a practice must have an effective risk management plan in place. Risk management involves all but

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Skipped

Correct answer Diversity of Staff

176 of 198 Term

Civil False Claims Statues is called

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Skipped

Correct answer CIA

177 of 198 Term

Which of the following are benefits for initiating quality efforts in a practice?

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Correct answer Reduce the risk of medical law suits, improve patient satisfaction, strengthen stability of the business, makes it twice as easy to recruit staff and providers. Safe, effective, Patient Centered care who is timely, efficient and equitable.

178 of 198 Term

Which are written plans required by OSHA?

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Correct answer Exposure Control Plan

179 of 198

Term

Components of a compliance plan

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Correct answer Designation fo a compliance officer, develop open lines of communication, investigation of allegations or violations

180 of 198 Term

A provider is a part of the Quality Payment Program if:

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Correct answer

The provider is in an APM (Advanced Payment Model) or bills more than $30,000 in Part B allowable charges and sees more than 100 Medicare patient sin a year

181 of 198 Term

Minimum necessary standards

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Correct answer Limiting access to the medical records to only those employees who need it for a specific purpose.

182 of 198 Term

Which of the following is essential for accurate charge capture?

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Skipped

Correct answer Review documentation of the services to make sure all codes are reported.

183 of 198 Term

What is best for an automated attendant in telephone triage system?

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Correct answer Limit number of options with clear, simple direction

184 of 198 Term

A common billing error is invalid or truncated ICD-10_CM codes.

How can you prevent this?

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Skipped

Correct answer Update the practice management system when new, deleted and revised codes are released.

185 of 198 Term

Procedure codes are reported by the facility using which code set?

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Correct answer ICD-10-PCS - Inpatient Hospital Facilities. Only submitted by FACILITIES!

186 of 198

Term

The front desk plays an important role in:

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Skipped

Correct answer Customer service, Optimizing physician time, Claim quality assurance

187 of 198 Term

What laws should you consider before purchasing big equipment with high reimbursement rates?

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Skipped

Correct answer

Stark and Anti-Kickback

188 of 198 Term

Which of the following includes the payment amount and denial explanations for claims submitted.

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Skipped

Correct answer Explanation of Benefits (EOB)

189 of 198 Term

Five physicians are setting up a group practice. They want to be able to issue stock as to a limited number of shareholders and where net income is not taxed at the entity level but flows through the physicians personal income tax return. Which corporate structure would best suit their needs?

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Correct answer S Corporation

190 of 198 Term

What is Telehealth/telemedicine?

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Correct answer A process by which medical care can be provided remotely through electronic media that does not include having a care provider physically present during the evaluation

191 of 198 Term

A MEDICARE PATIENT IS SEEN IN THE URGENT CARE CLINIC FOLLOWING A MINOR AUTOMOBILE ACCIDENT. THE PATEITN HAS MEDICARE PART A, B,AND C AS WELL AS No-FAULT THROUGH ATUO INSURANCE. WHO IS THE PRIMARY INSURANCE?

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Skipped

Correct answer Automobile No-fault

192 of 198 Term

What are some of the key trends addressed in healthcare reform?

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Correct answer

Healthcare is being targeted for major IT transformation, Shift from acute care to prevention and wellness, changing roles of physicians, care delivery will expand beyond the traditional physician office, coordination of care, focus on fraud and abuse, coding and documentation advancement

193 of 198 Definition

No, incident to services are not covered in a hospital setting - they can only be billed in the office setting or in a patient's home.

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Skipped

Correct answer P is hired by a cardiology practice to help see patients in the hospital. The PA performs all the rounds and notifies the physician on call if there are any patients that need to be seen by a physician. Is it appropriate to bill for the PAs services as incident-to?

194 of 198 Definition

Train all staff - Although training staff is important, it is NOT one of the key elements of change. Those include 1, embrace the change. 2, Define the future vision. 3, select agents of change. 4, Engage everybody. 5, Establish a clear support/reward plan

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Skipped

Correct answer Key elements of change management include all of the following except:

195 of 198 Term

Anti Kickback laws - OIG Resource?

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Skipped

Correct answer Fraud Alert

196 of 198

Term

What physician compensation mode is based on the work value for each procedure?

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Skipped

Correct answer Relative Value unit (RVU) model

197 of 198 Term

Which statement is true regarding disaster panning?

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Skipped

Correct answer Disaster plan should include patient data and practice management software at risk of possible interuptions.