1|Page
HFMA CSPR Exam ||Just Out!!!
Which fixed-rate payment method uses a single price for an
inpatient stay, outpatient procedure, or outpatient diagnosis if
charges exceed a threshold dollar amount?
A) Per diem payments
B) Carve-outs
C) Inpatient Stop-Loss
D) Case rate payments - ANSWER-D) Case rate payments
RBRVS is:
A) The relative weight for calculating MS-DRG payments
B) The relative weight for calculating OPPS payments
C) Mediare physician payment relative weights
D) Acronym for Real Based Reference Verification System -
ANSWER-C) Mediare physician payment relative weights
When explaining managed care, the most appropriate time
refers to:
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A) The least costly
B) The right amount of care provided (and will be billed and
paid for)
C) Medical intervention at the earliest possible time to prevent
a bad situation from becoming unnecessarily worse
D) The least intensive setting required to provide the care
appropriately - ANSWER-D) The least intensive setting required
to provide the care appropriately
Detailed contract performance assessments; negotiating-
strategy planning briefs; and financial and volume analysis
models are all:
A) Tools used to optimize contract performance
B) Key components of a typical contract audit
C) Performance evaluation tools
D) Contract evaluation criteria - ANSWER-A) Tools used to
optimize contract performance
The medical cost ratio is equal to the:
A) Total medical expenses divided by total premiums
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B) Total Medicare payments divided by the total premiums
C) Total resource allocation costs divided by total premiums
D) Total medical expenses divided by total revenue - ANSWER-
A) Total medical expenses divided by total premiums
The payment methodologies that could be used with
Accountable Care Organizations (ACO's) EXCEPT:
A) Fee-for-service payments
B) Risk sharing arrangements
C) Global payments
D) DRG's and APCs - ANSWER-A) Fee-for-service payments
CDHPs provide some benefits not found in a typical HMO or
PPO. All are CDHP benefits, EXCEPT:
A) Allowing consumers to purchase coverage for things not
typically covered
B) Consumers being required to track their own claims and
payments
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C) Representing an additional benefit plan choice tht adds to
the common dual-choice employer offerings
D) Fewer barriers to physician access - ANSWER-D) Fewer
barriers to physician access
The legislation that governs health benefit plans of self-insured,
self-funded employers in the United States is known as:
A) The Employee Retirement Income Security Act of 1974
(ERISA)
B) Det Norske Veritas
C) The 1986 Consolidated Omnibus Budget Reconcilliation Act
(COBRA)
D) The Health Maintenance Organization Act of 1973 -
ANSWER-A) The Employee Retirement Income Security Act of
1974 (ERISA)
To promote healthcare quality through accreditation and
certification programs, is the purpose of:
A) URAC
HFMA CSPR Exam ||Just Out!!!
Which fixed-rate payment method uses a single price for an
inpatient stay, outpatient procedure, or outpatient diagnosis if
charges exceed a threshold dollar amount?
A) Per diem payments
B) Carve-outs
C) Inpatient Stop-Loss
D) Case rate payments - ANSWER-D) Case rate payments
RBRVS is:
A) The relative weight for calculating MS-DRG payments
B) The relative weight for calculating OPPS payments
C) Mediare physician payment relative weights
D) Acronym for Real Based Reference Verification System -
ANSWER-C) Mediare physician payment relative weights
When explaining managed care, the most appropriate time
refers to:
,2|Page
A) The least costly
B) The right amount of care provided (and will be billed and
paid for)
C) Medical intervention at the earliest possible time to prevent
a bad situation from becoming unnecessarily worse
D) The least intensive setting required to provide the care
appropriately - ANSWER-D) The least intensive setting required
to provide the care appropriately
Detailed contract performance assessments; negotiating-
strategy planning briefs; and financial and volume analysis
models are all:
A) Tools used to optimize contract performance
B) Key components of a typical contract audit
C) Performance evaluation tools
D) Contract evaluation criteria - ANSWER-A) Tools used to
optimize contract performance
The medical cost ratio is equal to the:
A) Total medical expenses divided by total premiums
,3|Page
B) Total Medicare payments divided by the total premiums
C) Total resource allocation costs divided by total premiums
D) Total medical expenses divided by total revenue - ANSWER-
A) Total medical expenses divided by total premiums
The payment methodologies that could be used with
Accountable Care Organizations (ACO's) EXCEPT:
A) Fee-for-service payments
B) Risk sharing arrangements
C) Global payments
D) DRG's and APCs - ANSWER-A) Fee-for-service payments
CDHPs provide some benefits not found in a typical HMO or
PPO. All are CDHP benefits, EXCEPT:
A) Allowing consumers to purchase coverage for things not
typically covered
B) Consumers being required to track their own claims and
payments
, 4|Page
C) Representing an additional benefit plan choice tht adds to
the common dual-choice employer offerings
D) Fewer barriers to physician access - ANSWER-D) Fewer
barriers to physician access
The legislation that governs health benefit plans of self-insured,
self-funded employers in the United States is known as:
A) The Employee Retirement Income Security Act of 1974
(ERISA)
B) Det Norske Veritas
C) The 1986 Consolidated Omnibus Budget Reconcilliation Act
(COBRA)
D) The Health Maintenance Organization Act of 1973 -
ANSWER-A) The Employee Retirement Income Security Act of
1974 (ERISA)
To promote healthcare quality through accreditation and
certification programs, is the purpose of:
A) URAC
