CSPR - CERTIFIED SPECIALIST
PAYMENT REP (HFMA) UPDATED
EXAMS 2026/2027 WITH CORRECT
ANSWERS
1. DRG is used to classify - ANS ✅✅-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
2. Health Maintenance Organizations (HMO) - ANS ✅✅--Referrals
3. -PCP
4. -Patients must use an in-network provider for their services to
be covered.
5. -Reimbursement - majority of services offered are reimbursed
through capitation
6. payments (PMPM)
7. HMO Act of 1973 - ANS ✅✅-The HMO Act of 1973 gave
federally qualified HMOs the right to mandate that employers
offer their product to their employees under certain
conditions. Mandating an employer meant that employers who
had 25 or more employees and were for‐profit companies were
required to make a dual choice available to their employees.
8. Identify some key drivers of increasing healthcare costs - ANS
✅✅--Demographics
9. -Chronic Conditions
PAYMENT REP (HFMA) UPDATED
EXAMS 2026/2027 WITH CORRECT
ANSWERS
1. DRG is used to classify - ANS ✅✅-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
2. Health Maintenance Organizations (HMO) - ANS ✅✅--Referrals
3. -PCP
4. -Patients must use an in-network provider for their services to
be covered.
5. -Reimbursement - majority of services offered are reimbursed
through capitation
6. payments (PMPM)
7. HMO Act of 1973 - ANS ✅✅-The HMO Act of 1973 gave
federally qualified HMOs the right to mandate that employers
offer their product to their employees under certain
conditions. Mandating an employer meant that employers who
had 25 or more employees and were for‐profit companies were
required to make a dual choice available to their employees.
8. Identify some key drivers of increasing healthcare costs - ANS
✅✅--Demographics
9. -Chronic Conditions
