CSPPM Study Guide (Certified Specialist Physician Practice
Management) Exam Questions With Correct Answers
1. Encounter: Patient treatment during a defined period.A single-date occurrence at | | | | | | | | | |
a single provider
| | |
2. Purpose of Encounter: To provideinfo to the insuranceplan about the treatment the
| | | | | | | | | | | | |
patient received.
| |
3. Encounter report: * Patient & Provider demographic | | | | | |
*Detailed charges and services | | |
*Clinical information specific to the encounter | | | | |
4. CMS 1500: form for the encounter processing
| | | | | |
5. Time frame for Encounter reports to be submitted?: within 72 hours
| | | | | | | | | |
6. DAR: Days Accounts Receivable | | |
7. Key performance indicators (KPIs) for effective claims managment: DAR
| | | | | | | |
8. What will reduce the practice DAR?: Timely submitting encounters
| | | | | | | |
9. EDI: Electronic Date Interchange
| | |
10. Used to have an immediate electronic receipt and provide edit and audit
| | | | | | | | | | |
reports?: EDI
| |
11. Customer Patient Surveys: Tools to measure effective customer and patient | | | | | | | | |
relations
|
12. Advantage of Internal Surveys: *Address directly the issues of importance to | | | | | | | | | |
the practice
| |
*Less expensive than an external survey
| | | | |
*Can monitor trends over time
| | | |
13. Disadvantage of Internal Surveys: *Relaying on physician and staff to come up | | | | | | | | | | |
with questions
| |
*Skills sets to validate and develop questions
| | | | | |
*Patients will not answer questions if the staff is reviewing the questions
| | | | | | | | | | |
14. Advantage of External Surveys: *Professional experience to develop and val- | | | | | | | | |
idate the survey
| | |
*Provides benchmark performance from other practices | | | | |
15. Disadvantage of External Surveys: *Cash out of pocket cost | | | | | | | |
16. Methods of Pre-Registration: *Online patient registration by patient or staff | | | | | | | | |
*Mailing of new patient form | | | |
*Telephone call |
17. Fee-for-Service: Encounter paid at a contracted rate and applied to charge | | | | | | | | | |
18. Continuum of care: *Referred specialty care | | | | |
*Outside diagnostic testing services | | |
*Rehabilitation services |
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,*Local Hospital Services
| |
19. Components to manage risk: *Health Information Systems
| | | | | |
*Medical Records Documentation
| |
2 |/ |20
, *Quality Assurance Programs | |
*Case Management |
20. Management ofThird-party Receivables: *Encounter documented with retail | | | | | | |
charges
|
*Produce a claim or electronic format | | | | |
*All required documentation is attached
| | | |
21. ICD-10: Created in May 1990 by the 43rd World Health Assembly | | | | | | | | | |
22. ICD: International classification of diseases
| | | |
23. Contains about 70,000 codes: ICD-10 | | | |
24. What diagnosis codes that can not be coded?: *Probable | | | | | | | |
*Suspected
*Questionable
*Ruled out |
25. AMA: American Medical Association | | |
26. CPT: Current Procedural Terminology | | |
27. Who published the CPT?: AMA (American Medical Association)
| | | | | | |
28. CPT 5 sections: *Surgery | | |
*Anesthesia
*Pathology
*Radiology
*E/M services |
29. EHR: Electronic health record | | |
30. What is not a key component of E/M services?: Time | | | | | | | | |
31. RBRVS: Resource Based Relative Value System | | | | |
32. Based on the principle that payments for physicians services should vary
| | | | | | | | | |
with the resource cost for providing those services and is intended to improve
| | | | | | | | | | | | |
and stabilize the payment system while providing physician an avenue to
| | | | | | | | | | |
improve it: RBRVS
| | |
33. Three Components of Resource Consumption:: *Work related value (mea-
| | | | | | | |
sure of skill, training, and knowledge)
| | | | | |
*Physical resource or cost | | |
*Cost associated with malpractice insurance
| | | |
34. RVU: Relative Value Unit | | |
35. GPCI: Geographic Practice Cost Index | | | |
36. Applications for internal and external benchmarking:: *Expense per RVU | | | | | | | |
*Gross charge per RVU | | |
*Net revenue per RVU
| | |
*RVUs per physician | |
*RVU productivity by specialty
| | |
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Management) Exam Questions With Correct Answers
1. Encounter: Patient treatment during a defined period.A single-date occurrence at | | | | | | | | | |
a single provider
| | |
2. Purpose of Encounter: To provideinfo to the insuranceplan about the treatment the
| | | | | | | | | | | | |
patient received.
| |
3. Encounter report: * Patient & Provider demographic | | | | | |
*Detailed charges and services | | |
*Clinical information specific to the encounter | | | | |
4. CMS 1500: form for the encounter processing
| | | | | |
5. Time frame for Encounter reports to be submitted?: within 72 hours
| | | | | | | | | |
6. DAR: Days Accounts Receivable | | |
7. Key performance indicators (KPIs) for effective claims managment: DAR
| | | | | | | |
8. What will reduce the practice DAR?: Timely submitting encounters
| | | | | | | |
9. EDI: Electronic Date Interchange
| | |
10. Used to have an immediate electronic receipt and provide edit and audit
| | | | | | | | | | |
reports?: EDI
| |
11. Customer Patient Surveys: Tools to measure effective customer and patient | | | | | | | | |
relations
|
12. Advantage of Internal Surveys: *Address directly the issues of importance to | | | | | | | | | |
the practice
| |
*Less expensive than an external survey
| | | | |
*Can monitor trends over time
| | | |
13. Disadvantage of Internal Surveys: *Relaying on physician and staff to come up | | | | | | | | | | |
with questions
| |
*Skills sets to validate and develop questions
| | | | | |
*Patients will not answer questions if the staff is reviewing the questions
| | | | | | | | | | |
14. Advantage of External Surveys: *Professional experience to develop and val- | | | | | | | | |
idate the survey
| | |
*Provides benchmark performance from other practices | | | | |
15. Disadvantage of External Surveys: *Cash out of pocket cost | | | | | | | |
16. Methods of Pre-Registration: *Online patient registration by patient or staff | | | | | | | | |
*Mailing of new patient form | | | |
*Telephone call |
17. Fee-for-Service: Encounter paid at a contracted rate and applied to charge | | | | | | | | | |
18. Continuum of care: *Referred specialty care | | | | |
*Outside diagnostic testing services | | |
*Rehabilitation services |
1 |/ |20
,*Local Hospital Services
| |
19. Components to manage risk: *Health Information Systems
| | | | | |
*Medical Records Documentation
| |
2 |/ |20
, *Quality Assurance Programs | |
*Case Management |
20. Management ofThird-party Receivables: *Encounter documented with retail | | | | | | |
charges
|
*Produce a claim or electronic format | | | | |
*All required documentation is attached
| | | |
21. ICD-10: Created in May 1990 by the 43rd World Health Assembly | | | | | | | | | |
22. ICD: International classification of diseases
| | | |
23. Contains about 70,000 codes: ICD-10 | | | |
24. What diagnosis codes that can not be coded?: *Probable | | | | | | | |
*Suspected
*Questionable
*Ruled out |
25. AMA: American Medical Association | | |
26. CPT: Current Procedural Terminology | | |
27. Who published the CPT?: AMA (American Medical Association)
| | | | | | |
28. CPT 5 sections: *Surgery | | |
*Anesthesia
*Pathology
*Radiology
*E/M services |
29. EHR: Electronic health record | | |
30. What is not a key component of E/M services?: Time | | | | | | | | |
31. RBRVS: Resource Based Relative Value System | | | | |
32. Based on the principle that payments for physicians services should vary
| | | | | | | | | |
with the resource cost for providing those services and is intended to improve
| | | | | | | | | | | | |
and stabilize the payment system while providing physician an avenue to
| | | | | | | | | | |
improve it: RBRVS
| | |
33. Three Components of Resource Consumption:: *Work related value (mea-
| | | | | | | |
sure of skill, training, and knowledge)
| | | | | |
*Physical resource or cost | | |
*Cost associated with malpractice insurance
| | | |
34. RVU: Relative Value Unit | | |
35. GPCI: Geographic Practice Cost Index | | | |
36. Applications for internal and external benchmarking:: *Expense per RVU | | | | | | | |
*Gross charge per RVU | | |
*Net revenue per RVU
| | |
*RVUs per physician | |
*RVU productivity by specialty
| | |
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