CSPR - Certified Specialist Payment Rep
(HFMA) Q & As (Verified Answers) 2026
Steps used to control costs of managed care include: -
Correct Answers ✅Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
DRG is used to classify - Correct Answers ✅Inpatient
admissions for the purpose of reimbursing hospitals for each
case in a given category w/a negotiated fixed fee, regardless
of the actual costs incurred
Identify the various types of private health plan coverage -
Correct Answers ✅HMO
Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings
option; Private - Include higher patient out-of-pocket
expenditures for treatments that can serve to reduce
utilization/costs.
Managed care organizations (MCO) exist primarily in four
forms: - Correct Answers ✅Health Maintenance
Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
, CSPR - Certified Specialist Payment Rep
(HFMA) Q & As (Verified Answers) 2026
Identify the various types of government‐sponsored health
coverage: - Correct Answers ✅Medicare - Government;
Beneficiaries enrolled in such plans, but, participation in
these
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required
to select and enroll in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs -
Correct Answers ✅Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that
are designed to reward volume rather than quality,
outcomes, and prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
Health Maintenance Organizations (HMO) - Correct Answers
✅Referrals
PCP
(HFMA) Q & As (Verified Answers) 2026
Steps used to control costs of managed care include: -
Correct Answers ✅Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
DRG is used to classify - Correct Answers ✅Inpatient
admissions for the purpose of reimbursing hospitals for each
case in a given category w/a negotiated fixed fee, regardless
of the actual costs incurred
Identify the various types of private health plan coverage -
Correct Answers ✅HMO
Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings
option; Private - Include higher patient out-of-pocket
expenditures for treatments that can serve to reduce
utilization/costs.
Managed care organizations (MCO) exist primarily in four
forms: - Correct Answers ✅Health Maintenance
Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
, CSPR - Certified Specialist Payment Rep
(HFMA) Q & As (Verified Answers) 2026
Identify the various types of government‐sponsored health
coverage: - Correct Answers ✅Medicare - Government;
Beneficiaries enrolled in such plans, but, participation in
these
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required
to select and enroll in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs -
Correct Answers ✅Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that
are designed to reward volume rather than quality,
outcomes, and prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
Health Maintenance Organizations (HMO) - Correct Answers
✅Referrals
PCP
