CPPM Practice Management cheat sheet

Net collection rate = payments received ÷ (gross charges − contractual adjustments); a rate of 95% or higher is generally considered healthy.

Days in A/R = (total accounts receivable ÷ total charges) × number of days in the period; equivalently, total A/R ÷ average daily charges.

Gross collection ratio = total payments ÷ total gross charges, expressed as a percentage; it does not isolate payer performance the way the net collection rate does.

A/R aging buckets are conventionally 0–30, 31–60, 61–90, 91–120, and 120+ days; balances aging past 90–120 days carry elevated write-off risk.

Current ratio = current assets ÷ current liabilities; a value below 1.0 signals that short-term obligations exceed short-term assets.

Break-even point in units = total fixed costs ÷ (revenue per unit − variable cost per unit); the denominator is the contribution margin per unit.

Medicare payment = [(work RVU × work GPCI) + (PE RVU × PE GPCI) + (MP RVU × MP GPCI)] × the annually published conversion factor.

Straight-line depreciation expense = (acquisition cost − salvage value) ÷ estimated useful life in years.

Capitation pays a fixed per-member-per-month amount regardless of the volume or type of services the patient actually receives.

The Stark Law is a strict-liability civil statute barring physician self-referral of Medicare-payable designated health services unless a specific exception (e.g., in-office ancillary services) is satisfied; intent is not required.

The Anti-Kickback Statute is a criminal statute prohibiting remuneration intended to induce referrals of federally reimbursed items or services; the government must show at least one purpose was to induce referrals.

The civil False Claims Act allows treble damages plus per-claim civil penalties, and a qui tam relator generally receives 15%–30% of the recovery.

HIPAA breach notification: affected individuals must be notified without unreasonable delay and no later than 60 days after discovery; breaches involving 500+ residents of a state also require media notice.

The OIG's seven compliance program elements are written policies and procedures, a compliance officer and committee, training and education, communication lines, internal monitoring and auditing, disciplinary guidelines, and response and corrective action.

EMTALA requires a medical screening exam for anyone presenting to a Medicare-participating emergency department, stabilizing treatment, and a qualified transfer with certification when the patient cannot be stabilized.

The OSHA Bloodborne Pathogens Standard requires a written exposure control plan reviewed at least annually, hepatitis B vaccination offered within 10 working days of assignment, and training at initial assignment and annually.

HIPAA requires covered entities to retain compliance documentation, including policies and Security Rule records, for six years from the date of creation or last effective date.

FLSA exempt status requires both a salary basis test and a duties test (executive, administrative, professional, computer, or outside sales); non-exempt staff earn 1.5× the regular rate for hours over 40 in a workweek.

FMLA eligibility requires an employer with 50+ employees within 75 miles, and an employee with 12 months of service and 1,250 hours worked in the prior 12 months; leave entitlement is 12 weeks per 12-month period.

COBRA applies to employers with 20+ employees; continuation is generally 18 months for termination or reduced hours and up to 36 months for events such as divorce, death, or Medicare entitlement of the covered employee.

Form I-9 Section 2 (employer review of identity and employment authorization documents) must be completed within 3 business days of the employee's first day of work.

Under the ADA, an employer must provide reasonable accommodation unless it would impose undue hardship; job descriptions should list essential functions to support accommodation and hiring analysis.

Title VII of the Civil Rights Act covers employers with 15 or more employees and prohibits discrimination based on race, color, religion, sex, or national origin.

Workers' compensation is a no-fault system: the employee forgoes the right to sue the employer for work-related injury in exchange for scheduled benefits.

Progressive discipline typically escalates through verbal warning, written warning, suspension, and termination, with documentation at each step.

The HIPAA Security Rule requires three safeguard categories for electronic PHI: administrative safeguards, physical safeguards, and technical safeguards.

Audit controls are a required technical safeguard; systems must record and examine activity in information systems that contain or use ePHI.

The 3-2-1 backup rule: keep at least 3 copies of data, on 2 different media types, with 1 copy stored offsite.

The Promoting Interoperability (formerly Meaningful Use) program requires use of Certified EHR Technology (CEHRT) meeting ONC certification criteria.

A valid HIPAA authorization must contain a description of the information, the authorized recipients, the purpose, an expiration date or event, the individual's signature and date, a right-to-revoke statement, and a redisclosure statement.

HIPAA Safe Harbor de-identification requires removal of 18 specified identifiers, including names, geographic subdivisions smaller than a state, dates (except year), and full-face photographs.

Under the Security Rule, 'required' implementation specifications must be implemented; 'addressable' specifications must be implemented if reasonable and appropriate, or documented as not applicable with an equivalent alternative.

The PDSA cycle (Plan-Do-Study-Act) tests a small change, measures the result, and then adopts, adapts, or abandons it before the next cycle.

Six Sigma's DMAIC sequence is Define, Measure, Analyze, Improve, and Control.

Root cause analysis is the retrospective method used after a sentinel event; a fishbone (Ishikawa) diagram organizes candidate causes into categories such as people, process, equipment, and environment.

No-show rate = number of missed appointments ÷ number of scheduled appointments over the same period, expressed as a percentage.

The four elements of medical negligence that a plaintiff must prove are duty, breach of that duty, causation, and damages.

Informed consent requires disclosure of the diagnosis, the nature and purpose of the proposed procedure, material risks and benefits, reasonable alternatives, and the consequences of refusing.

CG-CAHPS is the standardized survey instrument used to measure patient experience in clinician and group practices, reporting composites such as access and communication.