CSPR - CERTIFIED SPECIALIST PAYMENT REP
(HFMA) LATEST EXAM WITH QUESTIONS AND
CORRECT ANSWERS (100%
CORRECT ANSWERS) CSPR CERTIFICATION EXAM
ANSWERED
(BRAND NEW!!)
Which of the following is not examined in a concurrent utilization
management review?
A) Case management
B) Discharge Planning
C) Physician group
D) Length of stay
C) Physician group
Which option is NOT a utilization management technique?
A) Retrospective UM Techniques
B) Prospective UM Techniques
C) Reimbursement UM Techniques
D) Concurrent UM Techniques C) Reimbursement UM Techniques
Medicare Part D:
A) Is part of the Medicare policy that provides outpatient prescription
drug coverage
B) Is a type of coverage that typically covers outpatient-type services
and physician services
C) Is a type of coverage intended to cover inpatient hospital care or
skilled nursing facility care
,D) Is part of the Medicare policy that allows private health insurance
companies to provide Medicare benefits
A) Is part of the Medicare policy that provides outpatient prescription drug
coverage
Medical loss ratio (MLR) is a synonymous term for:
A) Medical cost revenue (MCR)
B) Medical cost ratio (MCR)
C) Medical coverage revenue (MCR)
D) Medicaid cost ratio (MCR)
B) Medical cost ratio (MCR)
Key differences to consider between inpatient and outpatient services
when contracting include all of the following EXCEPT:
A) Site of service differentials
B) Payment methodologies
C) Patient experience and satisfaction
D) Operational policies and processes
C) Patient experience and satisfaction
Which of the following is not an example of an objective criteria set
that may be applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA
C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation
,A) Bundled payment
Integrated healthcare delivery systems are most capable of
successfully managing which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation
D) Global
capitation A
clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500
B) A properly completed billing form, UB-04 or CMS 1500
To ensure that patients have the education, tools, and support they
need to make decisions and participate in their own care is the goal
of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's)
B) A patient-centered medical home (PCMH)
With regards to managed care, a hospital's board of directors is
responsible for:
A) Understanding the hospital's contracting strategy
, B) Reviewing all managed care contracting arrangements C)
Ensuring appropriate IT is in a place to process claims
D) Safeguarding that the hospital pricing isn't available to consumers
B) Reviewing all managed care contracting arrangements
Deductibles, copayments, coinsurance, and out of pocket maximums
are all financial mechanisms of a benefit plan designed to:
A) Alleviate provider "revenue stress"
B) Subsidize costs
C) Share costs
D) Contain costs
C) Share costs
High-Deductible health plans are:
A) Private healthcare coverage which includes higher patient out-
of-pocket expenditures for treatments
B) Government healthcare coverage where beneficiaries are
required to select and enroll in a managed care plan
C) Government health care where beneficiaries enroll in such plans
but participation in these plans is voluntary
D) Private healthcare coverage that includes additional products
such as PPO and POS, with typically higher cost sharing
A) Private healthcare coverage which includes higher patient out-of-pocket
expenditures for treatments
(HFMA) LATEST EXAM WITH QUESTIONS AND
CORRECT ANSWERS (100%
CORRECT ANSWERS) CSPR CERTIFICATION EXAM
ANSWERED
(BRAND NEW!!)
Which of the following is not examined in a concurrent utilization
management review?
A) Case management
B) Discharge Planning
C) Physician group
D) Length of stay
C) Physician group
Which option is NOT a utilization management technique?
A) Retrospective UM Techniques
B) Prospective UM Techniques
C) Reimbursement UM Techniques
D) Concurrent UM Techniques C) Reimbursement UM Techniques
Medicare Part D:
A) Is part of the Medicare policy that provides outpatient prescription
drug coverage
B) Is a type of coverage that typically covers outpatient-type services
and physician services
C) Is a type of coverage intended to cover inpatient hospital care or
skilled nursing facility care
,D) Is part of the Medicare policy that allows private health insurance
companies to provide Medicare benefits
A) Is part of the Medicare policy that provides outpatient prescription drug
coverage
Medical loss ratio (MLR) is a synonymous term for:
A) Medical cost revenue (MCR)
B) Medical cost ratio (MCR)
C) Medical coverage revenue (MCR)
D) Medicaid cost ratio (MCR)
B) Medical cost ratio (MCR)
Key differences to consider between inpatient and outpatient services
when contracting include all of the following EXCEPT:
A) Site of service differentials
B) Payment methodologies
C) Patient experience and satisfaction
D) Operational policies and processes
C) Patient experience and satisfaction
Which of the following is not an example of an objective criteria set
that may be applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA
C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation
,A) Bundled payment
Integrated healthcare delivery systems are most capable of
successfully managing which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation
D) Global
capitation A
clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500
B) A properly completed billing form, UB-04 or CMS 1500
To ensure that patients have the education, tools, and support they
need to make decisions and participate in their own care is the goal
of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's)
B) A patient-centered medical home (PCMH)
With regards to managed care, a hospital's board of directors is
responsible for:
A) Understanding the hospital's contracting strategy
, B) Reviewing all managed care contracting arrangements C)
Ensuring appropriate IT is in a place to process claims
D) Safeguarding that the hospital pricing isn't available to consumers
B) Reviewing all managed care contracting arrangements
Deductibles, copayments, coinsurance, and out of pocket maximums
are all financial mechanisms of a benefit plan designed to:
A) Alleviate provider "revenue stress"
B) Subsidize costs
C) Share costs
D) Contain costs
C) Share costs
High-Deductible health plans are:
A) Private healthcare coverage which includes higher patient out-
of-pocket expenditures for treatments
B) Government healthcare coverage where beneficiaries are
required to select and enroll in a managed care plan
C) Government health care where beneficiaries enroll in such plans
but participation in these plans is voluntary
D) Private healthcare coverage that includes additional products
such as PPO and POS, with typically higher cost sharing
A) Private healthcare coverage which includes higher patient out-of-pocket
expenditures for treatments
