CDPMA cheat sheet

Organizational chart types: functional (departmentalized by skill, e.g., all billing staff under one manager) vs. line/team (staff grouped by service line or provider team); a matrix design assigns staff dual reporting lines and requires written clarification of authority.

Span of control: the number of direct reports per supervisor; wide spans (10+) suit standardized, routine roles, narrow spans (3-5) suit complex or high-risk roles such as clinical or compliance positions.

Policy vs. procedure: a policy states the required outcome or rule; a procedure states the step sequence and responsible party. Policies are approved by leadership and reviewed on a fixed cycle (commonly annually or on regulatory change).

Standard operating procedure elements: purpose, scope, responsible roles, step sequence, documentation/record produced, and revision history. Missing revision history is the most common audit failure in practice manuals.

Staffing calculation: annual productive hours = paid hours minus PTO, holidays, and training; required FTE = annual workload hours / annual productive hours per FTE.

Recruitment sequence: job analysis, job description, sourcing, screening, structured interview, reference and credential verification, offer, onboarding. Credential and license verification must be documented before independent patient contact.

Progressive discipline order: verbal counseling, written warning, final written warning, suspension, termination; each step requires contemporaneous documentation and consistent application across similarly situated employees.

Risk management cycle: identify exposures, classify by frequency and severity, select controls (avoid, reduce, transfer, retain), implement, monitor. Incident reports are non-punitive internal documents used for system improvement.

Emergency preparedness: a written plan must address fire, medical emergency, utility loss, and evacuation with assigned roles, posted exit routes, tested alarms, and documented drills.

Record retention: keep records at least as long as the longest applicable requirement among state statute, payer contract, and professional liability exposure; retain minor patients' records until the age of majority plus the state limitation period.

Amendment vs. correction: an erroneous entry is corrected by a dated, signed addendum referencing the original; the original entry is never erased, overwritten, or backdated.

Release of information requires a valid authorization: patient identity, specific information covered, recipient, purpose, expiration or event, signature and date, and right to revoke. A general or blanket consent is insufficient for most disclosures.

Minimum necessary standard applies to uses and disclosures for treatment, payment, and operations; it does not apply to disclosures to the patient or pursuant to a valid authorization.

Accounting of disclosures: track disclosures outside treatment, payment, and operations, including date, recipient, and purpose; the patient may request an accounting covering the prior six years.

Security safeguards: administrative (risk analysis, workforce training, access authorization), physical (locked storage, workstation placement, device disposal), and technical (unique user IDs, encryption, automatic logoff, audit logs).

Business associate agreement is required before a vendor handles protected health information; the covered entity remains responsible for verifying safeguards and reporting breaches.

Breach notification: notify affected individuals without unreasonable delay and no later than 60 days from discovery; notification to the regulator follows the same 60-day outer limit, with media notice for large breaches.

Destruction must render information unreadable and unrecoverable; maintain a destruction log recording date, method, record range, and the person performing destruction.

Gross collection ratio = total payments / total charges. Net collection ratio = total payments / (total charges minus contractual adjustments); the net ratio isolates collection performance from fee-schedule effects.

Accounts receivable days = (total AR / total charges) x days in period. A rising figure signals slower payment or billing delays, not necessarily higher revenue.

AR aging benchmarks: 0-30 days is current; the percentage of AR older than 90 days is the key liquidity indicator, and older balances require documented follow-up before write-off.

Adjustment categories: contractual (allowed amount below charge), bad debt (patient unwilling or unable to pay after collection effort), and administrative (charity care, small balance, or payer denial). Each affects reporting differently.

Revenue cycle sequence: scheduling, registration, eligibility and benefits verification, coding, charge capture, claim submission, denial management, payment posting, and patient collection.

Clean claim rate = claims accepted on first submission / total claims submitted; denials are managed by root-cause category (registration, eligibility, coding, authorization, medical necessity) with appeal deadlines tracked per payer.

Payer mix = payer payments / total payments; a shift toward lower-reimbursing payers changes the break-even visit volume even when total visits are unchanged.

Break-even volume = fixed costs / (revenue per unit minus variable cost per unit); fee-schedule changes alter the denominator and therefore the required volume.

Budget variance: favorable means revenue above or expense below budget; unfavorable means the reverse. Variance analysis separates volume effects from rate effects before corrective action is assigned.

Feedback model: describe the observed behavior, state its impact, and specify the expected behavior; feedback addresses behavior, not personality, and is delivered close to the event.

Conflict modes (Thomas-Kilmann): competing, collaborating, compromising, avoiding, accommodating. Collaborating suits high-stakes issues with time available; avoiding suits trivial issues or when a cooling period is needed.

Active listening components: attending, paraphrasing, reflecting feeling, clarifying with open questions, and summarizing; closed questions confirm facts, open questions surface concerns.

Team development stages: forming, storming, norming, performing, adjourning. Conflict during storming is expected and is resolved by clarifying roles and ground rules rather than by reassignment.

Communication channels: face-to-face carries the most cues and suits sensitive or complex messages; written channels suit documentation and repeatability; urgent safety messages require a channel with confirmed receipt.

Meeting discipline: stated purpose, timed agenda, assigned roles (facilitator, note-taker, timekeeper), documented decisions, and action items with owner and due date.

Performance appraisal elements: job-description-based criteria, behavioral examples, self-assessment, two-way discussion, development goals, and employee acknowledgment signature; the signature confirms receipt, not agreement.

Delegation requires matching authority to responsibility; the delegating manager retains accountability for the outcome and must define the deliverable, deadline, and reporting checkpoint.

Change management: communicate the reason for change, identify stakeholders and resisters, involve staff in design, provide training, and measure adoption; unaddressed resistance is the most common cause of failed implementation.