CMM Healthcare Management 2 — Questions and Answers
Question 1: Under HIPAA's Minimum Necessary Standard, a medical office manager should ensure staff access patient information:
- Only to the extent needed to perform their job function (Correct answer)
- Whenever a supervisor requests it
- In full whenever treatment is involved
- At their own discretion based on workflow
Correct answer: Only to the extent needed to perform their job function
The Minimum Necessary Standard limits PHI access to what is reasonably needed to accomplish a specific task.
Question 2: A healthcare organization's accounts receivable days outstanding (ARDO) has increased from 42 to 58 days. The BEST immediate action is to:
- Hire additional billing staff
- Audit the billing and coding workflow for bottlenecks (Correct answer)
- Renegotiate payer contracts
- Increase patient copay collection at time of service
Correct answer: Audit the billing and coding workflow for bottlenecks
Auditing the billing workflow identifies root causes of delayed reimbursement before implementing other solutions.
Question 3: Which accreditation body specifically focuses on ambulatory healthcare organizations?
- The Joint Commission
- AAAHC (Accreditation Association for Ambulatory Health Care) (Correct answer)
- NCQA
- URAC
Correct answer: AAAHC (Accreditation Association for Ambulatory Health Care)
AAAHC is the primary accrediting body specifically designed for ambulatory care settings.
Question 4: A physician practice wants to improve patient satisfaction scores. Which strategy has the MOST direct impact on scores?
- Reducing appointment wait times (Correct answer)
- Expanding office hours
- Adding a patient portal
- Installing new equipment
Correct answer: Reducing appointment wait times
Reducing wait times addresses one of the top patient complaints and most directly influences satisfaction survey results.
Question 5: When a medical practice transitions to a new EHR system, which phase is MOST critical for long-term success?
- Vendor selection
- Staff training and change management (Correct answer)
- Data migration
- Go-live support
Correct answer: Staff training and change management
Inadequate training and poor change management are the leading causes of EHR implementation failure.
Question 6: A practice manager notices a pattern of upcoded E&M visits. The FIRST step should be to:
- Report to the OIG immediately
- Conduct an internal audit to quantify the scope (Correct answer)
- Terminate the responsible coder
- Refund all payers immediately
Correct answer: Conduct an internal audit to quantify the scope
An internal audit establishes the scope of the problem and informs a proportional, defensible response.
Question 7: Under the Stark Law, a physician may NOT refer Medicare patients to an entity with which the physician has a financial relationship UNLESS:
- The referral is medically necessary
- A specific statutory exception applies (Correct answer)
- The patient provides written consent
- The entity is non-profit
Correct answer: A specific statutory exception applies
Stark Law prohibits self-referrals but provides numerous specific exceptions that must be strictly met.
CMM Healthcare Management 2
Under HIPAA's Minimum Necessary Standard, a medical office manager should ensure staff access patient information: