CMM FINAL STUDY GUIDE WITH ALL CORRECT & 100%
VERIFIED ANSWERS|ACTUAL COMPLETE EXAM|
ALREADY GRADED A+ (JUST RELEASED)
Steps of Revenue Cycle ✔Correct Answer-Patient Registration & Check in/ Clinical encounter/
Accurate Coding and Billing/ Claims Generation and Transmittal/ Processing Payments/ Preparation
and Transmittal of Patient Statements/ Collections and Finalizing Payments/ Denials, Appeals &
Refunds
Coding analysis ✔Correct Answer-involves analyzing the financial impact of proper vs. improper
coding procedures in practice
What type of codes reflect the accurate level of medical necessity that justfies each CPT and HCPC
level II code? ✔Correct Answer-ICD-10
Why is it important to have accurate coding ✔Correct Answer-minimizes denials and rejections
while ensuring the practice is reimbursed the full amount
All electronic opportunities to verfy active patient insurance and benefits should be utilized ___-
_____ hours before visit ✔Correct Answer-24-48 hours
If the patient does not have insurance, has a lapse in coverage, or cannot pay service, protect the
practice by having the patient sign a _____ _____ Notice or Notice of Non-coverage prior to being
seen ✔Correct Answer-Advance Beneficiary Notice
Electronic Medical Record and Practice Management Systems that are certified by CMS and the
Office of the National Coordinator for Health Information Technology (ONC) require to have built in
_________ Verification Systems. ✔Correct Answer-Insurance Verification Systems (IVS). NOTE:
Once activated they will automatically ping the insurance company
IVS will come back to the Practice management system (PMS) will highlight the appointment as
Green, Yellow, or Red. What does each color mean? ✔Correct Answer-Green - Verified and
Approved
Yellow - There may be a problem with this insurance
Red - Insurance is not active or out of network and do not participate
Most PMS systems have the ability to capture the IVS information in an electronic footprint that
occurs in the system. The information is held as a ______ ______ ✔Correct Answer-Virtual
Envelope
Even if the practice does not use EHR or EHR is not interfaced with the PMS, do they still have the
ability to access IVS system? ✔Correct Answer-Yes
Most insurance denials are due to what three reasons? ✔Correct Answer-Incorrect patient
demographics
invalid insurance information
ICD-10 code that is missing a seventh character required for that condition
,The claims process is streamlined and clean claims are paid electronically within ____ - ____ days
✔Correct Answer-14-21
Examples of what a CMM should do to achieve optimum reimbursement and compliance ✔Correct
Answer-Send staff to coding seminars or webinars regular due to frequent and signifcant changes
Hire certified coders and billing specialists
Ensure coding and billing staff are knowledgeable and familiar with reimbursement schedules of
insurance plans (pages 8-9 for more information)
NCCI ✔Correct Answer-National Correct Coding Initiative
Four parts of Medicare ✔Correct Answer-Part A
Part B
Part C
Part D
What does Medicare Part A Cover? ✔Correct Answer-Inpatient care in a hospital
Skilled nursing facility care
Nursing home care (inpatient care in a skilled nursing facility that's not custodial or long-term care)
Hospice care
Home health care
What does Medicare Part B Cover? ✔Correct Answer-Medically necessary services: Services or
supplies that are needed to diagnose or treat your medical condition and that meet accepted
standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when
treatment is most likely to work best.
What is Medicare Part C? ✔Correct Answer-A Medicare Advantage Plan (like an HMO or PPO) is
another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans,
sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare.
What is Medicare Part D? ✔Correct Answer-Medicare Drug Plan
A plan's list of covered drugs is called a "formulary," and each plan has its own formulary. Medicare
drug coverage typically places drugs into different levels, called "tiers," on their formularies. Drugs in
each tier have a different cost.
Medicare Part B RBRV ✔Correct Answer-Resource Based Relative Scale
RBRV is based on the product of what three numbers? ✔Correct Answer-Relative Value Units
(RVUs)
Geographic Practice Cost Indices (GPCI)
The national Conversion Factor (CF)
RSUs are the sum what three components? ✔Correct Answer-Physician's work
Practice expense and overhead
Malpractice
, Medicare Managed Care Plans ✔Correct Answer-these are health care choices such as HMO's. Part
C of the medicare program or premiums for supplemental insurance paid by the state through a
Medicaid managed care option
Medicare Write-Offs for Assigned Claims - What to Always write off? ✔Correct Answer-Always
write off:
-The difference between your actual charge and Medicare's allowed amount
-Covered services that have been denied if the patient's Waiver of Liability has not been obtained
(you cannot bill patient)
-Your appeals rights have been exhausted/choose not to appeal
Medicare Write-offs for Assigned Claims - What NOT to write off? ✔Correct Answer-The patients
20 percent co-insurance, yearly deductible, non-covered services, and denied services if waiver of
liability was not obtained
Medicare Write-offs for Non-assigned Claims - What to ALWAYS write off? ✔Correct Answer-
Covered services that have been denied if:
The patient's waiver of liability has not been obtained
Your appeal rights have been exhausted or you choose not to appeal
Medicare Write-offs for Non-assigned Claims - What NOT to write off? ✔Correct Answer-Patients
20 percent co-insurance
Patients yearly deductible
Covered services that have been denied if the patient Waiver of Liability has been obtained
The difference between your actual charge and the payment received from Medicare
Common reasons claim is considered "unclean" due to claims data errors (7) ✔Correct Answer-
Missing or invalid patient identification number of other patient information
Missing or invalid subscriber information (medicare number)
Failure to check the assignment box
Invalid dates of service
Missing or invalid modifers
Missing or invalid providers information
Incorrect place of services
What is a clearing house? ✔Correct Answer-A clearing house is a financial institution formed to
facilitate the exchange of payments, securities, or derivatives transactions.
VERIFIED ANSWERS|ACTUAL COMPLETE EXAM|
ALREADY GRADED A+ (JUST RELEASED)
Steps of Revenue Cycle ✔Correct Answer-Patient Registration & Check in/ Clinical encounter/
Accurate Coding and Billing/ Claims Generation and Transmittal/ Processing Payments/ Preparation
and Transmittal of Patient Statements/ Collections and Finalizing Payments/ Denials, Appeals &
Refunds
Coding analysis ✔Correct Answer-involves analyzing the financial impact of proper vs. improper
coding procedures in practice
What type of codes reflect the accurate level of medical necessity that justfies each CPT and HCPC
level II code? ✔Correct Answer-ICD-10
Why is it important to have accurate coding ✔Correct Answer-minimizes denials and rejections
while ensuring the practice is reimbursed the full amount
All electronic opportunities to verfy active patient insurance and benefits should be utilized ___-
_____ hours before visit ✔Correct Answer-24-48 hours
If the patient does not have insurance, has a lapse in coverage, or cannot pay service, protect the
practice by having the patient sign a _____ _____ Notice or Notice of Non-coverage prior to being
seen ✔Correct Answer-Advance Beneficiary Notice
Electronic Medical Record and Practice Management Systems that are certified by CMS and the
Office of the National Coordinator for Health Information Technology (ONC) require to have built in
_________ Verification Systems. ✔Correct Answer-Insurance Verification Systems (IVS). NOTE:
Once activated they will automatically ping the insurance company
IVS will come back to the Practice management system (PMS) will highlight the appointment as
Green, Yellow, or Red. What does each color mean? ✔Correct Answer-Green - Verified and
Approved
Yellow - There may be a problem with this insurance
Red - Insurance is not active or out of network and do not participate
Most PMS systems have the ability to capture the IVS information in an electronic footprint that
occurs in the system. The information is held as a ______ ______ ✔Correct Answer-Virtual
Envelope
Even if the practice does not use EHR or EHR is not interfaced with the PMS, do they still have the
ability to access IVS system? ✔Correct Answer-Yes
Most insurance denials are due to what three reasons? ✔Correct Answer-Incorrect patient
demographics
invalid insurance information
ICD-10 code that is missing a seventh character required for that condition
,The claims process is streamlined and clean claims are paid electronically within ____ - ____ days
✔Correct Answer-14-21
Examples of what a CMM should do to achieve optimum reimbursement and compliance ✔Correct
Answer-Send staff to coding seminars or webinars regular due to frequent and signifcant changes
Hire certified coders and billing specialists
Ensure coding and billing staff are knowledgeable and familiar with reimbursement schedules of
insurance plans (pages 8-9 for more information)
NCCI ✔Correct Answer-National Correct Coding Initiative
Four parts of Medicare ✔Correct Answer-Part A
Part B
Part C
Part D
What does Medicare Part A Cover? ✔Correct Answer-Inpatient care in a hospital
Skilled nursing facility care
Nursing home care (inpatient care in a skilled nursing facility that's not custodial or long-term care)
Hospice care
Home health care
What does Medicare Part B Cover? ✔Correct Answer-Medically necessary services: Services or
supplies that are needed to diagnose or treat your medical condition and that meet accepted
standards of medical practice.
Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when
treatment is most likely to work best.
What is Medicare Part C? ✔Correct Answer-A Medicare Advantage Plan (like an HMO or PPO) is
another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans,
sometimes called "Part C" or "MA Plans," are offered by private companies approved by Medicare.
What is Medicare Part D? ✔Correct Answer-Medicare Drug Plan
A plan's list of covered drugs is called a "formulary," and each plan has its own formulary. Medicare
drug coverage typically places drugs into different levels, called "tiers," on their formularies. Drugs in
each tier have a different cost.
Medicare Part B RBRV ✔Correct Answer-Resource Based Relative Scale
RBRV is based on the product of what three numbers? ✔Correct Answer-Relative Value Units
(RVUs)
Geographic Practice Cost Indices (GPCI)
The national Conversion Factor (CF)
RSUs are the sum what three components? ✔Correct Answer-Physician's work
Practice expense and overhead
Malpractice
, Medicare Managed Care Plans ✔Correct Answer-these are health care choices such as HMO's. Part
C of the medicare program or premiums for supplemental insurance paid by the state through a
Medicaid managed care option
Medicare Write-Offs for Assigned Claims - What to Always write off? ✔Correct Answer-Always
write off:
-The difference between your actual charge and Medicare's allowed amount
-Covered services that have been denied if the patient's Waiver of Liability has not been obtained
(you cannot bill patient)
-Your appeals rights have been exhausted/choose not to appeal
Medicare Write-offs for Assigned Claims - What NOT to write off? ✔Correct Answer-The patients
20 percent co-insurance, yearly deductible, non-covered services, and denied services if waiver of
liability was not obtained
Medicare Write-offs for Non-assigned Claims - What to ALWAYS write off? ✔Correct Answer-
Covered services that have been denied if:
The patient's waiver of liability has not been obtained
Your appeal rights have been exhausted or you choose not to appeal
Medicare Write-offs for Non-assigned Claims - What NOT to write off? ✔Correct Answer-Patients
20 percent co-insurance
Patients yearly deductible
Covered services that have been denied if the patient Waiver of Liability has been obtained
The difference between your actual charge and the payment received from Medicare
Common reasons claim is considered "unclean" due to claims data errors (7) ✔Correct Answer-
Missing or invalid patient identification number of other patient information
Missing or invalid subscriber information (medicare number)
Failure to check the assignment box
Invalid dates of service
Missing or invalid modifers
Missing or invalid providers information
Incorrect place of services
What is a clearing house? ✔Correct Answer-A clearing house is a financial institution formed to
facilitate the exchange of payments, securities, or derivatives transactions.
