HFMA CSPR Final Examination 2026
Updated with Correct Answers Graded
A+.
The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care Act - Answer D) The Affordable Care Act
Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
C) It allows the patients to have a choice of providers and physicians
D) Providers can work directly with employers to reduce the cost of providing insurance -
Answer D) Providers can work directly with employers to reduce the cost of providing
insurance
Accountable Care Organizations (ACOs) have all of the following characteristics EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record System - Answer B) Financial incentive for quantity of care
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be
transferred from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
,STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
D) Services provided by physicians - Answer B) Medicare Advantage health plan performance
To evaluate an organization's compliance with the CMS COP standards and other accreditation
requirements, is the purpose of:
A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claim - Answer A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per episode of
care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very low
premiums
C) An effort by insurers to increase premiums and to address calls from employers and the
public for improved quality
D) The ranking or classifying of one or more of the provider delivery system components to
influence choice - Answer D) The ranking or classifying of one or more of the provider
delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
, Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation ACT
(COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48
months for qualifying events
B) COBRA coverage begins on the date that healthcare coverage would otherwise have been
lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events to
be eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health
coverage for active employee - Answer A) COBRA beneficiaries generally are eligible for
group coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs because
patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plans - Answer B) Growth in high-
deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment - Answer C) Notifies member of non-covered
service
The appropriate addition of some risk in the exchange of health care to a patient for some form
Updated with Correct Answers Graded
A+.
The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care Act - Answer D) The Affordable Care Act
Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
C) It allows the patients to have a choice of providers and physicians
D) Providers can work directly with employers to reduce the cost of providing insurance -
Answer D) Providers can work directly with employers to reduce the cost of providing
insurance
Accountable Care Organizations (ACOs) have all of the following characteristics EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record System - Answer B) Financial incentive for quantity of care
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be
transferred from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
,STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
D) Services provided by physicians - Answer B) Medicare Advantage health plan performance
To evaluate an organization's compliance with the CMS COP standards and other accreditation
requirements, is the purpose of:
A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claim - Answer A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per episode of
care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very low
premiums
C) An effort by insurers to increase premiums and to address calls from employers and the
public for improved quality
D) The ranking or classifying of one or more of the provider delivery system components to
influence choice - Answer D) The ranking or classifying of one or more of the provider
delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
, Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation ACT
(COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48
months for qualifying events
B) COBRA coverage begins on the date that healthcare coverage would otherwise have been
lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events to
be eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health
coverage for active employee - Answer A) COBRA beneficiaries generally are eligible for
group coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs because
patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plans - Answer B) Growth in high-
deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment - Answer C) Notifies member of non-covered
service
The appropriate addition of some risk in the exchange of health care to a patient for some form
