CMM Revenue Cycle Management & Medical Billing 2

Question 1

Which metric best measures a practice's success in collecting payments from patients at or near the point of service?

Accepted Answer

Point-of-service (POS) cash collection rate

Answer

The point-of-service cash collection rate specifically measures the percentage of patient responsibility amounts collected at the time of the visit.

Question 2

A practice's net collection rate is 88%. This means the practice:

Accepted Answer

Failed to collect 12% of contractually allowable revenue

Answer

The net collection rate measures collections against net revenue (charges minus contractual adjustments), so 88% means 12% of allowable revenue was not collected.

Question 3

Which coding system is required for reporting diagnoses in all HIPAA-covered transactions in the United States?

Accepted Answer

ICD-10-CM

Answer

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is mandated for diagnosis coding in all HIPAA-covered electronic transactions.

Question 4

A medical manager notices that the practice's denial rate has risen to 15%. The first step in addressing this problem should be:

Accepted Answer

Analyze denial patterns by payer, code, and reason to identify root causes

Answer

Root cause analysis by denial category is the foundational step that reveals whether denials stem from coding, eligibility, authorization, or other systemic issues.

Question 5

Under the Stark Law (Physician Self-Referral Law), which of the following is TRUE?

Accepted Answer

Physicians are prohibited from referring Medicare/Medicaid patients to entities with which they have a financial relationship, absent an exception

Answer

The Stark Law prohibits physician self-referral for designated health services covered by Medicare/Medicaid unless a specific statutory or regulatory exception applies.

(CMM) Certified Medical Manager Practice Test

(CMM) Certified Medical Manager Practice Test

CMM Revenue Cycle Management & Medical Billing 2