AAPC Certified Physician Practice Manager (CPPM) Practice Test

These questions are part of the practice quiz. Start practicing

• In terms of HIPAA compliance, what is required from business associates?
• What does ICD-10-CM stand for?
• What purpose do Category III CPT Codes serve in medical billing?
• How short can the time frames for compliance stipulations in a CIA be?
• What could serious consequences of Stark Law violations include?
• What does MACRA stand for?
• What percentage of the total recovery may a whistleblower receive under a successful Qui Tam?
• Which tracks are included in CMS's quality payment program?
• How many years must pass for a patient to be considered a new patient?
• In relation to the Stark Law, what type of penalties may be imposed?
• Which of the following is NOT a requirement of an ABN?
• Which is NOT one of the four steps involved in a risk investigation?
• Which E/M Documentation Guidelines were used for office visits prior to January 1, 2021?
• Under MIPS, when is payment based on performance evaluated?
• What must entities maintain according to the OSHA Blood-borne Pathogens Standard?
• According to 1995 Documentation Guidelines, what depends on the number of body areas examined?
• How must services qualify to be considered "incident-to" when provided by a Non-Physician Practitioner (NPP)?
• What is the main purpose of the Privacy Rule under HIPAA?
• What factors are involved in calculating RBRVS payments?
• Which of the following is NOT one of the goals of HIPAA?
• What is one of the subcomponents of the history portion of an E/M service?
• What is the ultimate goal of using certified EHR according to the HITECH Act?
• Which of the following is NOT a component considered in RBRVS?
• Which provision of the FDCPA prohibits contacting a debtor at work if asked not to?
• What does the acronym MS-DRG stand for?
• Which of the following is NOT a type of Health Information Organization (HIO) managing Health Information Exchanges (HIEs)?
• What type of data is structured and often stored in relational tables?
• What does the acronym PECOS stand for?
• What is the purpose of the "Check" phase in the PDCA cycle?
• In a sole proprietorship, how are the physician and the practice treated for tax purposes?
• What is the maximum imprisonment term for knowingly violating the Anti-Kickback Law?
• What does the term "incident-to" services refer to in a medical practice?
• Which criteria determine the MIPS low-volume threshold?
• What distinguishes EHR from EMR?
• What does PDCA stand for?
• Which of the following is NOT a section of Category I CPT codes?
• Which group of professionals should be part of the same billing entity for incident-to services?
• What does FLSA stand for?
• How many days does it typically take for most carriers to credential a provider?
• What type of business corporation offers stock with or without voting rights?
• What is the final phase of the PDCA cycle?
• Which of the following is an example of a billing and coding error that may cause revenue fluctuations?
• According to the Anti-Kickback Law, what can be the maximum fine for violations?
• What is a necessary action after choosing the best technique in risk management?
• What is the primary limitation of issuing an ABN related to DME supplies?
• What is the primary purpose of the OIG Work Plan?
• Under HIPAA, what condition must be met for incidental disclosures to be permissible?
• How is the visit level primarily determined according to E/M guidelines?
• What does the term "Originating or Spoke Site" refer to in telehealth?
• What system can significantly reduce medication errors in patient care?
• What name is given to the state-based insurance exchange for individuals?
• What does Query-based Exchange (HIE) allow?
• What is a major drawback of a sole proprietorship structure?
• What is a key element of a Performance Improvement Plan?
• Which of the following is essential for the review of prior medical records in complexity analysis?
• What is the full form of SNOMED CT®?
• In risk management, which step involves assessing loss control techniques?
• True or False: The supervising physician does not need to be on-site when billing incident-to services.
• How must profits be distributed in S corporations?
• What is a common performance indicator for charge entry in a medical practice?
• MDM stands for which of the following?
• Which of the following can HIPAA-covered entities and business associates disclose PHI for?
• What is one of the key purposes of HITECH legislation?
• What is a key outcome expected from implementing computerized provider order entry?
• Which standard requires employers to document all occupational injuries and illnesses?
• What does RBRVS stand for?
• What does CPOE stand for?
• What is the function of a group purchasing organization (GPO)?
• What is a required element in a Performance Improvement Plan regarding timelines?
• The supervising physician must be where when incident-to services are provided?
• By which year will MIPS eligible clinicians/groups see a statutory increase in the performance threshold and payment adjustment?
• Which of the following is NOT considered a covered entity under HIPAA?
• Most large healthcare enterprises utilize which standards for data communication?
• What do Limited Liability Companies (LLCs) offer that partnerships do not?
• Violations of the Stark Law could result in what type of penalties?
• What requirement was removed from the definition of fraud by the Affordable Care Act of 2010?
• Which of the following is a key component of HCPCS?
• Which of the following is a provision that Advanced APM entities must agree to?
• ICD-10-PCS codes are primarily submitted by which type of entity?
• What is the primary focus of value-based purchasing in hospitals?
• What is the common outcome when a provider clones information in a patient's record?
• Who enforces the privacy standards under HIPAA?
• What is a primary responsibility of an Accountable Care Organization (ACO)?
• What are the three types of safeguards required by the HIPAA Security Rule?
• What type of organization is NOT a feature of Health Information Exchanges?
• What is the maximum civil monetary penalty that can be imposed per calendar year for a violation of HIPAA regulations?
• What major change occurred in the meaningful use program under the HITECH Act?
• What percentage of communication occurs through voice tone?
• MDM is selected based on which of the following components?
• What does it mean that MIPS is a budget-neutral program?
• Is intent required for a violation of the Stark Law regarding overpayment?
• Which of the following is NOT one of the four HIPAA code sets?
• What does the GX modifier signify?
• What percentage of the Medicare physician fee schedule is typically reimbursed for incident-to services supervised by NPPs?
• What is required for documenting an occupational injury under OSHA regulations?
• Which condition types influence the complexity of diagnoses?
• What type of tests fall under the category of high complexity according to CLIA?
• Which of the following is a privacy provision introduced by HITECH?
• Which phase of the PDCA cycle involves evaluating the implementation of the plan?
• What does the complexity of problems refer to in the context of MDM?
• What does cloning refer to in a patient's record?
• According to the Medical Group Management Association (MGMA), what percentage of denials are preventable?
• What must breach notifications include?
• For end-stage renal disease (ESRD) beneficiaries, Medicare is the secondary payer during which time frame?
• What does HCPCS Level II primarily consist of?
• In what year was the Health Insurance Portability and Accountability Act (HIPAA) enacted?
• What is the minimum complexity classification in lab testing according to CLIA?
• What is a qualifying reason for MIPS eligible clinicians to be excluded from reporting requirements?
• What is one of the criminal penalties for violating Anti-Kickback Laws?
• What is one right that patients have regarding their PHI under HITECH?
• What is a key component of a risk management strategy?
• When do annual updates to ICD-10-CM go into effect?
• Which of the following is a goal of the ACA?
• What is defined as the site where the provider delivering telehealth service is located?
• According to industry standards, after how many days should a collection agency be considered?
• Which of the following is a provision of the Fair Debt Collection Protection Act (FDCPA)?
• What is a primary function of a Clinical Data Warehouse (CDW)?
• What does the tiered physician compensation model allocate based on?
• What must an ABN specify?
• What does the term "clinical data" refer to in healthcare?
• In cash-based accounting, when are revenues recognized?
• What is the time frame within which Medicare overpayments must be returned under the ACA?
• Which of the following is a downside of C corporations?
• The subcomponents of the E/M history section include which of the following?
• What type of safeguards include measures like facility access controls under HIPAA?
• Which of the following is NOT a reason employers are allowed to terminate or discriminate against employees?
• What are the three key components of E/M coding based on the 1995 and 1997 documentation guidelines?
• What does the GA modifier indicate?
• What is a common reason for an employer not to base employment decisions on:
• Which method does CMS require for financial reports from inpatient providers?
• What is a situation where an ABN cannot be issued?
• What date do annual updates to HCPCS Level II codes take effect?
• True or False: Providers can switch between the 1995 and 1997 Documentation Guidelines from note to note.
• Why must the reason for Medicare payment denial be specified in an ABN?
• What is defined as the ability for patients to control the use of their health information among providers?
• How many types of identifiers for individuals are outlined by the Privacy Rule under HIPAA?
• Accrual accounting is recognized when revenues are:
• Which law pertains to the regulations surrounding fraudulent claims against the federal government?
• What does OSHA stand for?
• What are the CLIA classifications for the complexity of lab testing?
• What is a Clinical Data Repository (CDR)?
• HITECH was signed into law in 2009 as part of which act?
• Under the Stark Law, physicians are prohibited from referring patients to facilities where they have what type of interest?
• What does CLIA stand for?
• In E/M coding, the evaluation of how many body areas impacts the procedure level?
• What does 'Data' in MDM refer to?
• Under the False Claims Act, what is a key aspect of the Qui Tam provisions?
• Which type of findings would NOT be specifically targeted by the OIG Work Plan?
• What does HCPCS stand for?
• What factor can cause fluctuations in revenue for a medical practice?
• How many employees must be employed for FMLA to apply?
• Which of the following is NOT one of the CMS requirements for E/M encounter documentation?
• How many weeks of unpaid, job-protected leave can be granted under FMLA?
• Which of the following is not one of the performance metrics for value-based purchasing?
• Which of the following is NOT a specified use of certified EHR under the HITECH Act?
• What is the significance of Clinical Data Repositories in healthcare?
• What does ICD-10-PCS stand for?
• Which personal characteristic is protected from discrimination under employment law?
• In the PDCA cycle, what does “Plan” signify?
• What is the focus of the Merit-Based Incentive Payment System (MIPS)?
• Which organization is responsible for enforcing the insurance portability requirements under Title I of HIPAA?
• What does EMTALA stand for?
• What is Quality Control primarily concerned with?
• Another criminal penalty specific to the Anti-Kickback Law includes a potential prison term of up to how many years?
• What is the primary use of Category I CPT Codes?
• Which characteristic cannot be considered in employment decisions?
• What does OSHA stand for?
• What type of tests does CLIA waive regulation requirements for?
• What should be included in the ABN regarding the service cost?
• What is the definition of Directed Exchange in Health Information Exchange (HIE)?
• What does EDI stand for in the context of healthcare?
• Which item is crucial to include in a registration audit to ensure accurate billing?
• What is the potential fine for violating the Stark Law per service?
• Which component of MDM assesses the risk of complications or morbidity?
• Under accrual accounting, when are expenses recorded?
• If more than 500 individuals' information has been breached, which entities must be notified?
• Which phase corresponds with the implementation of the changes in the PDCA cycle?
• Current Procedural Terminology (CPT®) procedure codes are published by which organization?
• What amount can civil monetary penalties reach for violations of Anti-Kickback Laws?
• Is intent a necessary element for violating the Anti-Kickback Law?
• What is the purpose of the GZ modifier?
• What defines a Prospective Fee Schedule?
• Which of the following is NOT a MIPS performance category?
• What principle governs the minimal usage of information disclosed for treatment, payment, or operations?
• Which percentage reflects the part of communication that happens through general body language?
• Which coding system is primarily used for tracking procedural data?
• How long does an OIG imposed Corporate Integrity Agreement (CIA) typically last?
• What is not worth sending to a collections agency?
• Which is NOT a common performance issue related to charge entry?
• Which program aims to simplify federal regulation of payment and health IT?
• How many components are included in the Administrative Simplification provisions of HIPAA?
• What is the payment methodology used by Medicare based on CPT® codes?
• The goal of MIPS is to establish a single system for what purpose?
• For new patients, how many components of E/M level determination are required?
• What must business associates sign under HIPAA?
• Under the federal False Claims Act, what is the purpose of the Qui Tam statute?
• What is a potential consequence of violating the Stark Law?
• When must an ABN be delivered to the patient?
• Which payment model relies on historical data to determine payment amounts?
• Which type of history includes reviewing past medical, surgical, family, and social history?
• What does the acronym ORT stand for?
• Quality Assurance (QA) deals with setting policy and running what type of system?
• Under HIPAA, what must a covered entity do when handling PHI?
• Which types of tests require a Certificate of Compliance according to CLIA?
• What was one of the provisions in the HITECH Act regarding technology adoption?
• Within how many days must breach notifications be received following the discovery of a breach?
• What does the acronym LEIE stand for?
• Which of the following is a type of prospective payment method?
• What must be done to the plan during the "CHECK" phase of PDCA if outcomes do not meet benchmarks?
• What is one of MACRA's primary goals?
• What does the abbreviation "PHI" stand for in the context of breach notifications?
• NPPES stands for?
• How is the Discounted Fee for Service payment model characterized?
• What does the "CHECK" phase of PDCA compare outcomes to?
• What aim does HIPAA include regarding the transfer of health insurance coverage?
• Which Act provided federal funding for computerized medical records?
• Which of the following statements about incident-to billing is correct?
• What is the meaning of the acronym APC?
• Which of the following elements is necessary to support the medical necessity of services rendered?
• Which statement accurately reflects the necessity of an ABN?
• Which of the following is NOT an element of a registration audit?
• What must be true for a physician to actively participate in incident-to services?
• What does SHOP stand for in relation to insurance exchanges?
• What are the three parts of the Statement of Cash Flows?
• How often are the MIPS eligible clinicians/groups' performance thresholds increased?
• Which of the following is NOT a requirement for billing incident-to services?
• What types of items and services are exceptions to the routine notice ABN prohibition?
• Which four main categories of risk should be covered in policies and procedures?
• Which principle of documentation is emphasized when recording patient encounters?
• What happens to income in an LLC?
• What is the purpose of Category II CPT Codes?
• What type of penalties can violations of the Anti-Kickback Law lead to?
• Which payment method is based on a fixed amount per month per patient?
• What form is used to report the profits of a sole proprietorship?
• What part of communication is attributed to spoken words?
• In the context of medical documentation, what does 'legible' refer to?
• Fluctuations in adjustments should correlate with fluctuations in what?
• What does ACO stand for in healthcare terms?
• What are the factors that influence the amount and complexity of data to be analyzed?
• What document are healthcare providers required to have available for patients to read?
• What is NOT a key component of medical decision making in E/M coding?
• What does HL7 stand for?
• During which phase of PDCA is the plan implemented on a large scale after successful results?
• ABNs are not required for items or services that are either routinely non-covered or what else?
• Which piece of legislation, also known as the Kennedy-Kassebaum Bill, relates to patient health information?
• What is a major benefit of S corporations?
• What is the limit on the number of shareholders for S corporations?
• What does the "DO" phase of PDCA involve on a small scale?
• Under what circumstances can covered entities disclose Protected Health Information (PHI) without a signed authorization?
• What is the employee count threshold under the ACA for employers to receive a tax credit for providing health insurance?
• Which of the following is NOT a criterion for documenting an occupational illness or injury?
• What is an example of a professional risk that should be addressed in policies and procedures?
• Which of the following describes the method of calculating payments under a Prospective Fee Schedule?
• What is the definition of the Stark Law?