CSPR HFMA COMPREHENSIVE QUESTIONS AND
ANSWERS SURE A+
✔✔Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways, EXCEPT: -✔✔Ties to the healthcare
delivery industry rather than the insurance industry
✔✔Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways: -✔✔-Risk pooling
-Capitalization
-Network management
✔✔Which of the following is a service provided by a well-managed third-party
administrator (TPA)? -✔✔-Administrative
-Utilization review (UR)
-Claims processing
✔✔What is tiering? -✔✔The ranking or classifying of one or more of the provider
delivery system components
✔✔Which option is a practice used to control costs of managed care? -✔✔-Making
advance payment to providers for all services needed to care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment for each service.
✔✔Which option is a risk involved in per diem payments? -✔✔-The risk to the insurance
company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
✔✔Diagnosis-related group (DRG) is: -✔✔A payment category
, ✔✔How is the term carve-out used when discussing managed care? -✔✔To refer to
specific benefits or services
✔✔What is the term Coordination of Benefits (COB)? -✔✔A term used to describe how
payment is coordinated for patients who have coverage through two insurance policies
✔✔Which three components are used to determine the total RVU value for a service? -
✔✔-Malpractice expense
-Lowest market price for services used
-Medicare discounts
✔✔A fixed payment amount based upon the number of members assigned to a
provider, and does not vary based upon the number of services rendered, is known as: -
✔✔Capitation
✔✔Aligning incentives has come to mean _________. -✔✔The appropriate addition of
some risk in the exchange of health care to a patient for some form of remuneration.
✔✔According to MedPAC, which option is a benefit or undesirable consequence of
bundling
payments? -✔✔-It allows Medicare to pay a set fee per hospitalization episode.
-It would provide the potential to improve efficiency and quality
-It would lead to underutilization of services
✔✔As the healthcare industry moves to control growth in medical spending, what
initiative can help hospitals maintain their margins? -✔✔Contract standardization
✔✔Identify which initiatives are focused on in an effort to help increase an
organization's revenue/profit /margins. -✔✔-Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
✔✔What are rating tiers? -✔✔Different rates charged on the basis of the number and
relationships
✔✔What is the role of reinsurance? -✔✔Reinsurance seeks to limit a policyholder's
liability for catastrophic claims
✔✔Which option is a major trend in case management? -✔✔-Shift from broad-based
toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
ANSWERS SURE A+
✔✔Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways, EXCEPT: -✔✔Ties to the healthcare
delivery industry rather than the insurance industry
✔✔Provider service organizations (PSOs) function like health maintenance
organizations (HMOs) in all of the following ways: -✔✔-Risk pooling
-Capitalization
-Network management
✔✔Which of the following is a service provided by a well-managed third-party
administrator (TPA)? -✔✔-Administrative
-Utilization review (UR)
-Claims processing
✔✔What is tiering? -✔✔The ranking or classifying of one or more of the provider
delivery system components
✔✔Which option is a practice used to control costs of managed care? -✔✔-Making
advance payment to providers for all services needed to care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment for each service.
✔✔Which option is a risk involved in per diem payments? -✔✔-The risk to the insurance
company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
✔✔Diagnosis-related group (DRG) is: -✔✔A payment category
, ✔✔How is the term carve-out used when discussing managed care? -✔✔To refer to
specific benefits or services
✔✔What is the term Coordination of Benefits (COB)? -✔✔A term used to describe how
payment is coordinated for patients who have coverage through two insurance policies
✔✔Which three components are used to determine the total RVU value for a service? -
✔✔-Malpractice expense
-Lowest market price for services used
-Medicare discounts
✔✔A fixed payment amount based upon the number of members assigned to a
provider, and does not vary based upon the number of services rendered, is known as: -
✔✔Capitation
✔✔Aligning incentives has come to mean _________. -✔✔The appropriate addition of
some risk in the exchange of health care to a patient for some form of remuneration.
✔✔According to MedPAC, which option is a benefit or undesirable consequence of
bundling
payments? -✔✔-It allows Medicare to pay a set fee per hospitalization episode.
-It would provide the potential to improve efficiency and quality
-It would lead to underutilization of services
✔✔As the healthcare industry moves to control growth in medical spending, what
initiative can help hospitals maintain their margins? -✔✔Contract standardization
✔✔Identify which initiatives are focused on in an effort to help increase an
organization's revenue/profit /margins. -✔✔-Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
✔✔What are rating tiers? -✔✔Different rates charged on the basis of the number and
relationships
✔✔What is the role of reinsurance? -✔✔Reinsurance seeks to limit a policyholder's
liability for catastrophic claims
✔✔Which option is a major trend in case management? -✔✔-Shift from broad-based
toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
