CSPR - Certified Specialist Payment Rep (HFMA) EXAM 2025 ACTUAL
TEST COMPREHENSIVE QUESTIONS AND COMPLETE VERIFIED ANSWERS
( CORRECT DETAILED & ELABORATED) 100% SOLVED ALREADY GRADED
A+/ 2025!!
What is the term Coordination of Benefits (COB)? - ANSWER-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? - ANSWER--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: - ANSWER-
Capitation
Aligning incentives has come to mean _________. - ANSWER-
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? - ANSWER--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? - ANSWER-Contract standardization
As the healthcare industry moves to control growth in medical
spending, what initiative can NOT help hospitals maintain their
margins? - ANSWER--Pay-for-performance programs
-Health savings accounts
-Price transparency
Identify which initiatives are focused on in an effort to help
increase an organization's revenue/profit /margins. - ANSWER--
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? - ANSWER-Different rates charged on the
basis of the number and relationships
What is the role of reinsurance? - ANSWER-Reinsurance seeks
to limit a policyholder's liability for catastrophic claims
Which option is a major trend in case management? -
ANSWER--Shift from broad-based toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
What type of provider authorization is applied in emergency
cases, where prior authorization is impossible? - ANSWER-
Concurrent
What is utilization management (UM)? - ANSWER-A tool to
control the costs of providing healthcare services to enrollees
Which of the following statements is true about disease
management (DM)? - ANSWER-DM programs encourage
patients to assume some control over their disease state
What is the function of catastrophic case management (CM)? -
ANSWER-It is used to manage diseases in patients with very
high costs of care.
, What is demand management? - ANSWER-A coordinated effort
by the MCO, employers, and providers to control the utilization
of medical services and resources
All of the following are effective contract evaluation criteria,
EXCEPT: - ANSWER-Detailed contract performance
assessments
All of the following are effective contract evaluation criteria: -
ANSWER--General payer or provider criteria
-Reimbursement levels and parameters
-Provider costs and responsibilities
The following are tools for optimizing contract performance,
EXCEPT: - ANSWER-Contract language
The following are tools for optimizing contract performance: -
ANSWER--Financial and volume analysis models.
-Managed care contract dashboard.
-Detailed contract performance assessments.
Which option is considered a key difference between inpatient
and outpatient contracting? - ANSWER--Reimbursement
methodology differences
TEST COMPREHENSIVE QUESTIONS AND COMPLETE VERIFIED ANSWERS
( CORRECT DETAILED & ELABORATED) 100% SOLVED ALREADY GRADED
A+/ 2025!!
What is the term Coordination of Benefits (COB)? - ANSWER-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? - ANSWER--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: - ANSWER-
Capitation
Aligning incentives has come to mean _________. - ANSWER-
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? - ANSWER--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? - ANSWER-Contract standardization
As the healthcare industry moves to control growth in medical
spending, what initiative can NOT help hospitals maintain their
margins? - ANSWER--Pay-for-performance programs
-Health savings accounts
-Price transparency
Identify which initiatives are focused on in an effort to help
increase an organization's revenue/profit /margins. - ANSWER--
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? - ANSWER-Different rates charged on the
basis of the number and relationships
What is the role of reinsurance? - ANSWER-Reinsurance seeks
to limit a policyholder's liability for catastrophic claims
Which option is a major trend in case management? -
ANSWER--Shift from broad-based toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
What type of provider authorization is applied in emergency
cases, where prior authorization is impossible? - ANSWER-
Concurrent
What is utilization management (UM)? - ANSWER-A tool to
control the costs of providing healthcare services to enrollees
Which of the following statements is true about disease
management (DM)? - ANSWER-DM programs encourage
patients to assume some control over their disease state
What is the function of catastrophic case management (CM)? -
ANSWER-It is used to manage diseases in patients with very
high costs of care.
, What is demand management? - ANSWER-A coordinated effort
by the MCO, employers, and providers to control the utilization
of medical services and resources
All of the following are effective contract evaluation criteria,
EXCEPT: - ANSWER-Detailed contract performance
assessments
All of the following are effective contract evaluation criteria: -
ANSWER--General payer or provider criteria
-Reimbursement levels and parameters
-Provider costs and responsibilities
The following are tools for optimizing contract performance,
EXCEPT: - ANSWER-Contract language
The following are tools for optimizing contract performance: -
ANSWER--Financial and volume analysis models.
-Managed care contract dashboard.
-Detailed contract performance assessments.
Which option is considered a key difference between inpatient
and outpatient contracting? - ANSWER--Reimbursement
methodology differences
