Free CSPPM Practice Questions

Question 1

A physician sees a patient for the first time, but another physician of the same specialty and subspecialty in the group treated the patient 18 months ago. Today, the physician manages hypertension and type 2 diabetes, both at their documented treatment goals. The physician reviews one laboratory result, evaluates medication effectiveness and adverse effects, and renews the prescriptions. No additional data are reviewed, and code selection is based on medical decision making rather than time. Which office/outpatient E/M code is supported?

Accepted Answer

99214: established patient, moderate medical decision making

Answer

99204: new patient, moderate medical decision making

Answer

99213: established patient, low medical decision making

Answer

99215: established patient, high medical decision making

Question 2

After a practice raises its list charges, its gross collection rate falls from 64% to 52%, while its net collection rate remains 97%. The comparison uses similar, fully settled service cohorts; payer allowances and write-off practices are unchanged. Net collection rate uses charges less contractual adjustments as its denominator. What should the administrator conclude from this combination of results?

Accepted Answer

Higher list charges lowered the gross ratio, not the share of collectible revenue recovered.

Answer

The practice is collecting a smaller share of its valid receivables.

Answer

Longer payment delays explain the lower gross rate, even though both service cohorts are fully settled.

Answer

Contracted reimbursement per comparable service has fallen despite higher list charges.

Question 3

The monthly operating budget for a practice assumes 900 completed visits, $36,000 in fixed costs, and $18 in variable cost per visit. Actual volume is 1,050 visits and actual total cost is $57,900. This volume remains within the capacity covered by the fixed-cost budget. To evaluate spending separately from the cost of serving more patients, which variance should the administrator report?

Accepted Answer

$3,000 unfavorable, compared with the budget at actual volume

Answer

$5,700 unfavorable, compared with the original total budget

Answer

$2,700 unfavorable, representing the cost of the additional visits

Answer

$3,000 favorable, after scaling the entire budget to actual volume

Question 4

At registration, a 69-year-old retiree presents an Original Medicare card and a group health plan card. The group coverage comes through the patient's spouse, who is currently working for an employer that has consistently employed 60 people. The patient has no other coverage or special Medicare coordination circumstances. How should the practice sequence these payers?

Accepted Answer

The group plan is primary because coverage is through a currently employed spouse at an employer with at least 20 employees.

Answer

Medicare is primary because the patient receiving the service is retired, even though the spouse continues to work.

Answer

Medicare is primary because an employer must have at least 100 employees before its group plan pays ahead of Medicare.

Answer

The plan that covered the patient first is primary; the practice must establish the effective dates of both policies.

Question 5

A cardiologist treating an adult patient requests the patient's medication list and recent laboratory results from the primary care practice. Staff have verified the cardiologist's identity and secure delivery destination. No special confidentiality law or agreed disclosure restriction applies. The records clerk has held the request because there is no signed release. Which instruction should the practice manager give?

Accepted Answer

Send the requested records securely for the patient's treatment without a separate authorization.

Answer

Obtain the patient's written authorization because the cardiologist works for a different practice.

Answer

Execute a business associate agreement before transmitting records to the treating cardiologist.

Answer

Provide the medication list verbally, but retain the laboratory reports until the patient signs a release.

Question 6

A practice has unused appointment capacity and receives a one-time offer for 200 visits at a guaranteed collected amount of $80 per visit. Its usual charge is $150. Each additional visit costs $35; the cost report also allocates $55 of existing fixed overhead per visit. Accepting the work will neither displace other patients nor add fixed costs, and clinical and contractual requirements are satisfied. On short-term financial grounds, how should the offer be evaluated?

Accepted Answer

Accept it: the visits would increase operating income by $9,000.

Answer

Reject it: the visits would reduce operating income by $2,000 after allocated overhead.

Answer

Accept it: the visits would increase operating income by the full $16,000 collected.

Answer

Accept it: the visits would increase operating income by $23,000 using the usual charge.

Question 7

A physician changes claims-made malpractice insurers on January 1, 2026. The old policy ends December 31, 2025, with no extended reporting coverage. The new policy is in force throughout 2026 and includes prior-acts coverage back to January 1, 2022, matching the old policy's retroactive date. A claim concerning care delivered in 2024 is first made and promptly reported in July 2026. There was no prior knowledge of the claim, and all other coverage conditions are met. Which coverage analysis is correct?

Accepted Answer

The new policy responds because its prior-acts coverage includes the 2024 care.

Answer

The old policy responds because it was active when the physician delivered the care.

Answer

Neither policy responds because the physician did not purchase a tail from the former insurer.

Answer

Both policies respond because their identical retroactive dates create overlapping coverage for the act.

Question 8

A practice's aging report lists 30 unpaid claims for one commercial payer. The clearinghouse transmitted them, but the payer's front-end acknowledgments rejected them for invalid subscriber identifiers; none reached adjudication. The contract requires accepted claims within 120 days of service, and 105 days have elapsed. How should the billing team protect the practice's filing rights?

Accepted Answer

Verify and correct the subscriber identifiers, resubmit the claims, and confirm payer acceptance.

Answer

File payment appeals with the original transmission receipts as evidence that the claims were sent.

Answer

Keep the claims in payer follow-up until the usual adjudication interval has elapsed from transmission.

Answer

Submit the unchanged claims on paper to bypass the payer's electronic front-end edits.

Question 9

Physicians in a multispecialty group have markedly different payer mixes. The owners want the productivity component of compensation to reflect the volume and intensity of each physician's personally performed work, without making that component depend on negotiated payer rates or collection delays. Which payment basis most closely matches that objective?

Accepted Answer

A uniform dollar amount per credited physician work RVU

Answer

An equal base salary per clinical full-time equivalent

Answer

A uniform percentage of the physician's net collections

Answer

A fixed payment per completed encounter, regardless of intensity

Question 10

During a payer negotiation, the administrator models the two services covered by the proposed fee schedule. Annual volume is expected to remain 1,200 routine visits and 300 longer visits. The current allowances are $95 and $190, respectively; the proposed allowances are $105 and $170. All allowed amounts are collected, and operating costs are unchanged. Compared with the current contract, what is the proposal's annual financial effect for this service mix?

Accepted Answer

A $6,000 increase in revenue and operating income

Answer

A $12,000 increase in revenue and operating income

Answer

A $6,000 decrease in revenue and operating income

Answer

A $7,500 decrease in revenue and operating income

Free CSPPM Practice Questions

Domain 1: Encounter Processing, Customer Relations and Registration Procedures

Question 1

Domain 2: Physician Coding and Payment Systems

Question 2

Domain 3: Revenue Cycle: Accounts Receivable, Consumerism, and Collections

Question 3

Question 4

Domain 5: Budgeting and Benchmarking

Question 5

Domain 6: Cost Analysis and Management

Question 6

Domain 7: Physician Compensation and Retirement

Question 7

Domain 8: Integrated Health Systems, Contracting and Reimbursement

Question 8

Domain 9: Physician Practice Insurance

Question 9

Domain 11: Legal, Compliance and Regulatory Issues

Question 10

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