CPPM/AAPC EXAM QUESTIONS AND ANSWERS
LATEST UPDATE (GRADED A+)
Revenue Per Visit (RPV)
Total amount collected divides by the total number of patient visits
Advance Benefit Notification (ABN)
Notification given to patients advising Medicare may not cover a certain procedure or service
Payment for fee for service is based on
CPT & HCPCS Level II
MCO
Private Health Plan
Place of Service (POS) determines correct reimbursement when
The professional component for services provided in a facility (I.e. HOD) are less than when provided in
a physician office as the physician doesn't have any practice 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 time and claim quality assurance are key components to which
role?
Front Desk
What can result in claim denial?
Incorrect POS, incorrect NPI, and a truncated diagnosis code
Patients are prepared to make payments at the time of there visits when?
Payment & collection policies are prominently posted in the office
What is the most important criteria to meet for the selection of Evaluation and Management (E/M)
codes?
Medical necessity
What code set represents healthcare equipment, drugs and supplies?
ICD-10.PCS
, ICD-10-CM
International Classification of Diseases, Tenth Revision, Clinical Modification CM codes represent the
diagnosis/reason a service is performed.
ICD-10-PCS
International Classification of Diseases, Revision Procedural Coding System. These represent procedures
performed at inpatient hospital facilities
CPT codes
current procedural terminology represent procedures performed & bilked by physicians and non-
physicians practitioners (APP's)
HCPCS Level II
for products and supplies and services not included in level I. the code is alphanumeric
Clean Claim Form
A form that is complete and accurate and includes all provider information and other 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 APP's to report professional services?
CPT & HCPCS Level Ii
Procedure codes are reported using which codes?
CPT
Medicare patient with Parts A, B & C and no fault auto insurance is seen in the ED following a minor
auto accident, who is the primary insurance?
Auto No-Fault
What is the first thing to review when a private payer repeatedly denies a specific code (o.e.
Venipuncture)?
Payer Contract to see if denial is appropriate
Vital component of medical coding
Codes based on complete and accurate medical record documentation in the patients chart
How often should you run a productivity report?
Twice a year, minimally
What is one purpose for a productivity report?
LATEST UPDATE (GRADED A+)
Revenue Per Visit (RPV)
Total amount collected divides by the total number of patient visits
Advance Benefit Notification (ABN)
Notification given to patients advising Medicare may not cover a certain procedure or service
Payment for fee for service is based on
CPT & HCPCS Level II
MCO
Private Health Plan
Place of Service (POS) determines correct reimbursement when
The professional component for services provided in a facility (I.e. HOD) are less than when provided in
a physician office as the physician doesn't have any practice 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 time and claim quality assurance are key components to which
role?
Front Desk
What can result in claim denial?
Incorrect POS, incorrect NPI, and a truncated diagnosis code
Patients are prepared to make payments at the time of there visits when?
Payment & collection policies are prominently posted in the office
What is the most important criteria to meet for the selection of Evaluation and Management (E/M)
codes?
Medical necessity
What code set represents healthcare equipment, drugs and supplies?
ICD-10.PCS
, ICD-10-CM
International Classification of Diseases, Tenth Revision, Clinical Modification CM codes represent the
diagnosis/reason a service is performed.
ICD-10-PCS
International Classification of Diseases, Revision Procedural Coding System. These represent procedures
performed at inpatient hospital facilities
CPT codes
current procedural terminology represent procedures performed & bilked by physicians and non-
physicians practitioners (APP's)
HCPCS Level II
for products and supplies and services not included in level I. the code is alphanumeric
Clean Claim Form
A form that is complete and accurate and includes all provider information and other 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 APP's to report professional services?
CPT & HCPCS Level Ii
Procedure codes are reported using which codes?
CPT
Medicare patient with Parts A, B & C and no fault auto insurance is seen in the ED following a minor
auto accident, who is the primary insurance?
Auto No-Fault
What is the first thing to review when a private payer repeatedly denies a specific code (o.e.
Venipuncture)?
Payer Contract to see if denial is appropriate
Vital component of medical coding
Codes based on complete and accurate medical record documentation in the patients chart
How often should you run a productivity report?
Twice a year, minimally
What is one purpose for a productivity report?
