CPPM Practice Management flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Net collection rate

Payments received divided by gross charges minus contractual adjustments. It measures how much of the collectible revenue the practice actually collected, with 95% or higher generally considered strong.

Days in accounts receivable

Total accounts receivable divided by average daily charges, or (A/R divided by total charges) multiplied by the number of days in the period. It estimates how long collections take.

Current ratio

A liquidity measure calculated as current assets divided by current liabilities. A result below 1.0 indicates the practice cannot cover short-term obligations with short-term assets.

Break-even point

The volume at which total revenue equals total cost, calculated as fixed costs divided by the contribution margin per unit (revenue per unit minus variable cost per unit).

Relative value unit formula

Payment equals the sum of work, practice expense, and malpractice RVUs each multiplied by its geographic practice cost index, with that total multiplied by the Medicare conversion factor.

Straight-line depreciation

An accounting method that allocates an asset's cost evenly across its useful life, calculated as acquisition cost minus salvage value, divided by the number of years of useful life.

Capitation

A payment model in which the practice receives a fixed per-member-per-month amount for each enrolled patient regardless of how many services that patient actually uses.

Stark Law

A strict-liability civil statute prohibiting physicians from referring Medicare-payable designated health services to entities with which they have a financial relationship, unless a specific regulatory exception applies.

Anti-Kickback Statute

A criminal law prohibiting knowingly offering or receiving remuneration to induce referrals of items or services payable by federal healthcare programs. The government need only show inducement was one purpose.

False Claims Act

A civil statute imposing treble damages and per-claim penalties for knowingly submitting false claims to federal programs; a qui tam relator typically receives 15% to 30% of the recovery.

HIPAA breach notification deadline

Affected individuals must be notified without unreasonable delay and no later than 60 days after discovery of a breach; breaches affecting 500 or more state residents also require media notice.

OIG compliance program elements

Seven elements: 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 obligations

Medicare-participating hospitals must provide an appropriate medical screening exam, stabilize the emergency condition, and, when transfer is required, obtain a qualified transfer with physician certification.

Bloodborne Pathogens Standard

An OSHA rule requiring a written exposure control plan reviewed annually, hepatitis B vaccination offered within 10 working days of assignment, and training at assignment and annually thereafter.

FLSA exempt classification

Exemption from overtime requires both payment on a salary basis and meeting a duties test such as executive, administrative, professional, computer, or outside sales; non-exempt staff earn 1.5 times the regular rate over 40 hours.

FMLA eligibility

Requires an employer with 50 or more employees within 75 miles and an employee with 12 months of service and 1,250 hours worked in the prior year; entitlement is 12 weeks per 12 months.

COBRA continuation periods

Applies to employers with 20 or more employees; continuation generally lasts 18 months for termination or reduced hours and up to 36 months for events such as divorce or death.

Form I-9 deadline

Employers must complete Section 2, reviewing documents establishing identity and employment authorization, within three business days of the employee's first day of work for pay.

ADA undue hardship

The legal standard allowing an employer to decline a requested accommodation that would impose significant difficulty or expense, considering factors such as business size, resources, and the nature of the operation.

Progressive discipline

A structured escalation of corrective action, typically verbal warning, written warning, suspension, and termination, with each step documented in the employee's personnel file.

HIPAA Security Rule safeguards

Three required categories protecting electronic protected health information: administrative safeguards such as risk analysis and workforce training, physical safeguards such as facility access controls, and technical safeguards such as access control and encryption.

Audit controls

A required technical safeguard under the HIPAA Security Rule requiring hardware, software, and procedural mechanisms that record and examine activity in systems containing or using electronic protected health information.

3-2-1 backup rule

A data protection practice of maintaining at least three copies of data, stored on two different media types, with one copy kept offsite to survive a local disaster.

Certified EHR Technology

An electronic health record system tested and certified by an ONC-authorized certification body against required criteria, a prerequisite for attesting to Promoting Interoperability or Meaningful Use objectives.

HIPAA authorization elements

A valid authorization states the information to be disclosed, recipients, purpose, expiration date or event, the individual's signature and date, the right to revoke, and a redisclosure statement.

Safe Harbor de-identification

A HIPAA method of de-identifying data by removing 18 specified identifiers, including names, geographic subdivisions smaller than a state, dates other than year, and full-face photographs.

PDSA cycle

Plan-Do-Study-Act: a rapid-cycle improvement method in which a small change is planned, tested, studied for results, and then adopted, adapted, or abandoned before the next cycle.

DMAIC

The Six Sigma improvement sequence of Define, Measure, Analyze, Improve, and Control, used to reduce process variation and sustain gains through ongoing monitoring.

Root cause analysis

A retrospective structured review conducted after a sentinel event to identify underlying system failures rather than individual blame, often organized with a fishbone diagram of contributing categories.

No-show rate

The number of appointments patients missed without cancelling divided by the total number of scheduled appointments in the same period, expressed as a percentage.

Negligence elements

A malpractice plaintiff must prove four elements: the defendant owed a duty of care, breached that standard, caused the injury, and produced legally recognizable damages.

Informed consent elements

Disclosure of the diagnosis, the nature and purpose of the proposed procedure, material risks and benefits, reasonable alternatives, and the consequences of declining the recommended treatment.