CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) 2024
x x x x x x x
QUESTIONS WITH COMPLETE SOLUTIONS.
x x x
THIS EXAM CONTAINS:
x x
Cspr - Certified Specialist Payment Rep
x x x x x
Hfma
Questions With Complete Solutions.
x x x
1|P a g
x x x x
,1. Steps x used to control costs of managed care include
x x x x x x x
..ANS>> Bundled x x codes x x Capitation
Payer and Provider to agree on reasonable payment
x x x x x x x
2. DRG x is used to classify
x x x
..ANS>> Inpatient admissions for the purpose of reimbursing hospitals for each case in
x x x x x x x x x x x x a given category
x x
x w/a negotiated fixed fee, regardless of the actual costs incurred
x x x x x x x x x
3. Identify x x the various types x x x x x x of private health
x x x x x x plan coverage
x x
..ANS>> HMO x Conventional
PPO and POS
x x x
HDHP/SO plans - high-deductible health plans with a savings option; Private - Include higher patient out-of-pocket
x x x x x x x x x x x x x x x
x expenditures for treatments that can serve to reduce utilization/costs.
x x x x x x x x
4. Managed x care organizations (MCO) exist primarily in four forms
x x x x x x x
..ANS>> Health Mainte- x x
x nance Organizations (HMO)
x x
Preferred Provider Organizations (PPO) Point of
x x x x x
2|P a g
x x x x
, Service (POS) Organizations Exclusive Provider
x x x x
x Organizations (EPO) x
5. Identify the various types of government‐sponsored health coverage
..ANS>> Medicare x x
- Government; Beneficiaries enrolled in such plans, but, participation in these plans is
x x x x x x x x x x x x
x voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select and enroll in a managed care plan.
x x x x x x x x x x x x x x x x
x Medicare Managed Care (a.k.a. Medicare Advantage Plans)
x x x x x x
6. Identify x x some x x key drivers of
x x x x x x increasing x x healthcare costs x x
..ANS>>
x Demographics Chronic x
x Conditions
Provider payment systems - Provider payment systems that are designed to reward volume rather than quality, outcomes, and
x x x x x x x x x x x x x x x x x
x prevention Consumer Perceptions Health Plan
x x x x
pressure Physician Relationships
x x
Supply Chain
x x
3|P a g
x x x x
, 7. Health Maintenance Organizations (HMO)
x ..ANS>> Referrals
x PCP
4|P a g
x x x x
x x x x x x x
QUESTIONS WITH COMPLETE SOLUTIONS.
x x x
THIS EXAM CONTAINS:
x x
Cspr - Certified Specialist Payment Rep
x x x x x
Hfma
Questions With Complete Solutions.
x x x
1|P a g
x x x x
,1. Steps x used to control costs of managed care include
x x x x x x x
..ANS>> Bundled x x codes x x Capitation
Payer and Provider to agree on reasonable payment
x x x x x x x
2. DRG x is used to classify
x x x
..ANS>> Inpatient admissions for the purpose of reimbursing hospitals for each case in
x x x x x x x x x x x x a given category
x x
x w/a negotiated fixed fee, regardless of the actual costs incurred
x x x x x x x x x
3. Identify x x the various types x x x x x x of private health
x x x x x x plan coverage
x x
..ANS>> HMO x Conventional
PPO and POS
x x x
HDHP/SO plans - high-deductible health plans with a savings option; Private - Include higher patient out-of-pocket
x x x x x x x x x x x x x x x
x expenditures for treatments that can serve to reduce utilization/costs.
x x x x x x x x
4. Managed x care organizations (MCO) exist primarily in four forms
x x x x x x x
..ANS>> Health Mainte- x x
x nance Organizations (HMO)
x x
Preferred Provider Organizations (PPO) Point of
x x x x x
2|P a g
x x x x
, Service (POS) Organizations Exclusive Provider
x x x x
x Organizations (EPO) x
5. Identify the various types of government‐sponsored health coverage
..ANS>> Medicare x x
- Government; Beneficiaries enrolled in such plans, but, participation in these plans is
x x x x x x x x x x x x
x voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select and enroll in a managed care plan.
x x x x x x x x x x x x x x x x
x Medicare Managed Care (a.k.a. Medicare Advantage Plans)
x x x x x x
6. Identify x x some x x key drivers of
x x x x x x increasing x x healthcare costs x x
..ANS>>
x Demographics Chronic x
x Conditions
Provider payment systems - Provider payment systems that are designed to reward volume rather than quality, outcomes, and
x x x x x x x x x x x x x x x x x
x prevention Consumer Perceptions Health Plan
x x x x
pressure Physician Relationships
x x
Supply Chain
x x
3|P a g
x x x x
, 7. Health Maintenance Organizations (HMO)
x ..ANS>> Referrals
x PCP
4|P a g
x x x x
