AAPC CPPM Certified Physician Practice Manager

Which type of healthcare provider is authorized to practice medicine independently, including prescribing medications and performing surgery?

• ACertified nursing assistant
• BPhysician (MD or DO)
• CHealth information technician
• DMedical assistant

What is the first step in the typical patient flow process in an outpatient physician office?

• AClaims submission
• BCharge capture
• CInsurance verification
• DPatient scheduling

An 'incident-to' service in a physician office requires all of the following EXCEPT:

• AThe physician must be physically present in the office suite
• BThe service must be a part of the patient's ongoing treatment
• CThe service must be performed by the physician personally
• DThe physician must have initiated the plan of care

Which of the following best describes a benefit of utilizing mid-level providers such as nurse practitioners or physician assistants in a medical practice?

• AThey improve patient access, revenue, and patient satisfaction
• BThey are less expensive to credential than physicians
• CThey eliminate the need for physician oversight entirely
• DThey can only see patients for wellness visits

Which place of service code is used for services rendered in a physician's office?

• A21
• B22
• C23
• D11

The revenue cycle begins when:

• AA patient determines the need for services and calls to schedule an appointment
• BPayment is posted to the patient's account
• CThe physician documents the encounter note
• DA claim is submitted to the payer

According to MGMA data, what percentage of claim denials are considered preventable?

• A80 percent
• B70 percent
• C50 percent
• D90 percent

Which of the following is the correct sequence of steps in the revenue cycle?

• AScheduling, registration, charge capture, claims submission, denial management, payment p…
• BPayment posting, claims submission, charge capture, registration
• CClaims submission, charge capture, scheduling, payment posting
• DCharge capture, registration, scheduling, denial management

What does 'A/R days' measure in a physician practice?

• AThe number of days a physician sees patients per week
• BThe number of days before an insurance policy becomes effective
• CThe average number of days it takes to collect payment after a service is rendered
• DThe total days in the accounting period

A practice's accounts receivable aging report shows that 60% of A/R is in the 0-30 day bucket. Which interpretation is most accurate?

• AThe practice should immediately send all accounts to collections
• BThe practice needs to reduce its patient volume
• CThe practice has poor collection performance
• DThe practice has a healthy collection rate with most receivables being recent

What is a 'clean claim' in medical billing?

• AA claim that has been audited by the compliance department
• BA claim submitted with all required data elements that can be processed without additiona…
• CA claim submitted for preventive care services only
• DA claim that has been paid in full

When verifying a patient's insurance eligibility, which of the following should be confirmed?

• AOnly the patient's employer information
• BOnly whether the patient has a valid insurance card
• CCoverage status, effective dates, copay amounts, deductible status, and referral requirem…
• DOnly the patient's name and date of birth

Which federal law prohibits offering or receiving anything of value to induce or reward referrals for services covered by federal healthcare programs?

• AHIPAA Privacy Rule
• BAnti-Kickback Statute
• CStark Law
• DFalse Claims Act

The Stark Law (Physician Self-Referral Law) specifically prohibits physicians from:

• AHiring family members in their practice
• BAccepting cash payments from patients
• CReferring patients for designated health services to entities with which the physician ha…
• DTreating Medicare patients

Which entity publishes the annual OIG Work Plan that identifies areas of focus for fraud and abuse enforcement?

• ACenters for Medicare & Medicaid Services (CMS)
• BOffice of Inspector General (OIG) of the Department of Health and Human Services
• CThe Joint Commission
• DAmerican Medical Association (AMA)

Which of the following is one of the seven elements of an effective compliance program as outlined by the OIG?

• AAnnual reduction in staff headcount
• BMandatory overtime for all employees
• CElimination of all patient copays
• DDesignation of a compliance officer and compliance committee

Under the False Claims Act, a person who knowingly submits a false claim to a federal healthcare program may face:

• ATreble damages (three times the amount of the false claim) plus per-claim penalties
• BLoss of state medical license only
• CMandatory imprisonment with no option for a fine
• DOnly a written warning from CMS

Which compliance concept refers to submitting claims for services that are more complex or expensive than what was actually provided?

• AUpcoding
• BBalanced billing
• CUnbundling
• DDowncoding

The HIPAA Privacy Rule gives patients the right to:

• ASelect which insurance company processes their claim
• BRefuse to pay for services already rendered
• CRequest access to and obtain a copy of their protected health information
• DDemand that their physician prescribe specific medications

Under HIPAA, what is the maximum timeframe a covered entity has to respond to a patient's request to access their medical records?

• A10 business days
• B30 calendar days, with a possible 30-day extension
• C60 business days
• D90 calendar days

Which of the following is considered protected health information (PHI) under HIPAA?

• ADe-identified aggregate statistical data about hospital admissions
• BPublished clinical research data with all identifiers removed
• CGeneric health information from a medical textbook
• DA patient's name linked to their diagnosis in a medical record

The HIPAA Security Rule requires covered entities to implement safeguards in which three categories?

• AClinical, financial, and operational
• BInternal, external, and environmental
• CLegal, ethical, and procedural
• DAdministrative, physical, and technical

A medical practice discovers that a laptop containing unencrypted ePHI of 600 patients was stolen. Under the HIPAA Breach Notification Rule, the practice must:

• ANotify affected individuals, the HHS Secretary, and prominent media outlets in the state
• BTake no action since the data was on a laptop, not a server
• CNotify only the Office of Inspector General
• DOnly notify the affected patients within 60 days

Which HIPAA-defined entity performs functions or activities on behalf of a covered entity that involve the use or disclosure of PHI?

• AHealth plan
• BCovered entity
• CClearinghouse
• DBusiness associate

What is the minimum necessary standard under HIPAA?

• APractices must keep a minimum number of years of medical records
• BCovered entities must use the minimum amount of PHI necessary to accomplish the intended…
• CPatients must provide a minimum amount of information at registration
• DInsurance companies must reimburse a minimum percentage of billed charges

CPT codes are maintained and published by which organization?

• AAmerican Medical Association (AMA)
• BAmerican Academy of Professional Coders (AAPC)
• CCenters for Medicare & Medicaid Services (CMS)
• DWorld Health Organization (WHO)

ICD-10-CM codes are primarily used for what purpose in a physician practice?

• ATracking inventory of medical supplies
• BDetermining employee payroll
• CReporting diagnoses and reasons for patient encounters
• DReporting procedures performed during surgery

The Resource-Based Relative Value Scale (RBRVS) used by Medicare to determine physician payment is based on which three components?

• APhysician work, practice expense, and malpractice expense
• BBase rate, modifier, and facility fee
• COverhead costs, profit margin, and market demand
• DPatient volume, geographic location, and specialty type

What does the term 'allowed amount' mean in insurance reimbursement?

• AThe amount charged by the hospital for facility fees
• BThe maximum amount an insurance plan will pay for a covered service
• CThe total amount billed by the physician for a service
• DThe amount the patient pays out of pocket

A participating provider with a Medicare patient bills $200 for a service. Medicare's allowed amount is $120, and Medicare pays 80%. What is the patient's financial responsibility?

• A$80
• B$24
• C$40
• D$200

Which modifier is used to indicate that a procedure was performed on the left side of the body?

• AModifier -59
• BModifier -25
• CModifier -76
• DModifier -LT

What is the purpose of a fee schedule in a medical practice?

• ATo list the salaries of all employees
• BTo document patient satisfaction scores
• CTo track the operating hours of the practice
• DTo establish the standard charges for each procedure and service the practice offers

In a managed care environment, what is a 'capitation' payment model?

• AThe payer reimburses the provider for each individual service rendered
• BThe provider receives a fixed per-member-per-month payment regardless of services provided
• CThe patient pays the full cost of services upfront
• DThe provider charges a percentage of annual revenue as an access fee

An Explanation of Benefits (EOB) is sent to:

• AThe patient (or subscriber) by the insurance company
• BThe state insurance commissioner
• COnly the healthcare provider
• DOnly the employer of the insured

What is the primary purpose of a chart of accounts in medical office accounting?

• ATo organize all financial transactions into categorized accounts for accurate reporting
• BTo store patient medical records
• CTo track patient appointments
• DTo maintain physician credentialing files

Which financial statement shows a practice's revenues, expenses, and net income over a specific period?

• AIncome statement (profit and loss statement)
• BStatement of cash flows
• CAccounts receivable aging report
• DBalance sheet