CSPR - Certified Specialist Payment Rep (HFMA) 2024
Questions With Complete Solutions.
According to MedPAC, which -It allows Medicare to pay a set fee per hospitalization episode.
option is a benefit or -It would provide the potential to improve efficiency and quality
undesirable consequence of
-It would lead to underutilization of services
bundling payments?
,Advanced Beneficiary Although typically covered by Medicare, the following
Notice (ABN): Potential services are likely to be denied for lack of medical necessity
Service Denials under the circumstances described below:
-Lab Tests - Lab tests (for example, complete blood count)
when the diagnosis code does not support Medicare's
definition of medical necessity.
-Pap Smear - A screening Pap smear and pelvic exam given
more often than every two years, unless the beneficiary is in
a category for which annual exams are covered
-Screening Fecal Occult Blood Test - A screening fecal occult
blood test given more often than annually or if the
beneficiary is younger than 50 years
-Screening flexible sigmoidoscopy - A screening flexible
sigmoidoscopy given more often
than every four years or if the beneficiary is younger than 45
years
-Prostate Cancer Screening - A prostate cancer screening
test given more often than annually or if the beneficiary is
younger than 50 years
-Tetanus vaccine - A tetanus vaccine given prophylactically
(as compared to one given because the patient stepped on
a rusty nail) -Local Medical Review Policy (LMRP) - Any
service that does not meet the coverage criteria established
in Local Medical Review Policy (LMRP). Some Medicare
carriers have established specific coverage criteria. For
example, some carriers have established LMRPs for
common office procedures such as removal of benign skin
lesions. You can find LMRPs through the website of your
local Medicare carrier.
, Aligning incentives has come The appropriate addition of some risk in the exchange of
to mean _________. health care to a patient for some form of remuneration.
All of the following are -General payer or provider criteria
effective contract evaluation -Reimbursement levels and parameters
criteria:
-Provider costs and responsibilities
All of the following are Detailed contract performance assessments
effective contract evaluation
criteria, EXCEPT:
All of the following are -Fiduciary matters
responsibilities of a -Legal affairs
provider organization's
-Policy matters
Board of Directors:
All of the following are Implementation issues
responsibilities of a
provider organization's
Board of Directors, EXCEPT:
All of the following should be -Member volumes by product type
analyzed prior to and/or -Historical reimbursement levels by product type -Historical
during contract negotiations: claims payment and/or submission problems
Historical member premiums
All of the following should be
analyzed prior to and/or
during contract negotiations,
EXCEPT:
Questions With Complete Solutions.
According to MedPAC, which -It allows Medicare to pay a set fee per hospitalization episode.
option is a benefit or -It would provide the potential to improve efficiency and quality
undesirable consequence of
-It would lead to underutilization of services
bundling payments?
,Advanced Beneficiary Although typically covered by Medicare, the following
Notice (ABN): Potential services are likely to be denied for lack of medical necessity
Service Denials under the circumstances described below:
-Lab Tests - Lab tests (for example, complete blood count)
when the diagnosis code does not support Medicare's
definition of medical necessity.
-Pap Smear - A screening Pap smear and pelvic exam given
more often than every two years, unless the beneficiary is in
a category for which annual exams are covered
-Screening Fecal Occult Blood Test - A screening fecal occult
blood test given more often than annually or if the
beneficiary is younger than 50 years
-Screening flexible sigmoidoscopy - A screening flexible
sigmoidoscopy given more often
than every four years or if the beneficiary is younger than 45
years
-Prostate Cancer Screening - A prostate cancer screening
test given more often than annually or if the beneficiary is
younger than 50 years
-Tetanus vaccine - A tetanus vaccine given prophylactically
(as compared to one given because the patient stepped on
a rusty nail) -Local Medical Review Policy (LMRP) - Any
service that does not meet the coverage criteria established
in Local Medical Review Policy (LMRP). Some Medicare
carriers have established specific coverage criteria. For
example, some carriers have established LMRPs for
common office procedures such as removal of benign skin
lesions. You can find LMRPs through the website of your
local Medicare carrier.
, Aligning incentives has come The appropriate addition of some risk in the exchange of
to mean _________. health care to a patient for some form of remuneration.
All of the following are -General payer or provider criteria
effective contract evaluation -Reimbursement levels and parameters
criteria:
-Provider costs and responsibilities
All of the following are Detailed contract performance assessments
effective contract evaluation
criteria, EXCEPT:
All of the following are -Fiduciary matters
responsibilities of a -Legal affairs
provider organization's
-Policy matters
Board of Directors:
All of the following are Implementation issues
responsibilities of a
provider organization's
Board of Directors, EXCEPT:
All of the following should be -Member volumes by product type
analyzed prior to and/or -Historical reimbursement levels by product type -Historical
during contract negotiations: claims payment and/or submission problems
Historical member premiums
All of the following should be
analyzed prior to and/or
during contract negotiations,
EXCEPT:
