CSPR - Certified Specialist Payment Rep
(HFMA) Exam Questions + Verified
Answers 100% correct, Update
Steps used to control costs of managed care include -
correct answer ✅Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
DRG is used to classify -
correct answer ✅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
Identify the various types of private health plan coverage -
correct answer ✅1-HMO
2-Conventional
3-PPO and POS
4-HDHP/SO plans - high-deductible health plans with a savings
option; Private - Include higher patient out-of-pocket expenditures
for treatments that can serve to reduce utilization/costs.
Managed care organizations (MCO) exist primarily in four forms: -
correct answer ✅1- Health Maintenance Organizations (HMO)
, CSPR - Certified Specialist Payment Rep
(HFMA) Exam Questions + Verified
Answers 100% correct, Update
2- Preferred Provider Organizations (PPO)
3- Point of Service (POS) Organizations
4- Exclusive Provider Organizations (EPO)
Identify the various types of government‐sponsored health
coverage: -
correct answer ✅1. Medicare - Government; Beneficiaries enrolled
in such plans, but, participation in these
plans is voluntary.
2. Medicaid
3. Medicaid Managed Care - Medicaid beneficiaries are required to
select and enroll in a managed care plan.
4. Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs -
correct answer ✅-Demographics
-Chronic Conditions
-Provider payment systems - Provider payment systems that are
designed to reward volume rather than quality, outcomes, and
prevention
(HFMA) Exam Questions + Verified
Answers 100% correct, Update
Steps used to control costs of managed care include -
correct answer ✅Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
DRG is used to classify -
correct answer ✅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
Identify the various types of private health plan coverage -
correct answer ✅1-HMO
2-Conventional
3-PPO and POS
4-HDHP/SO plans - high-deductible health plans with a savings
option; Private - Include higher patient out-of-pocket expenditures
for treatments that can serve to reduce utilization/costs.
Managed care organizations (MCO) exist primarily in four forms: -
correct answer ✅1- Health Maintenance Organizations (HMO)
, CSPR - Certified Specialist Payment Rep
(HFMA) Exam Questions + Verified
Answers 100% correct, Update
2- Preferred Provider Organizations (PPO)
3- Point of Service (POS) Organizations
4- Exclusive Provider Organizations (EPO)
Identify the various types of government‐sponsored health
coverage: -
correct answer ✅1. Medicare - Government; Beneficiaries enrolled
in such plans, but, participation in these
plans is voluntary.
2. Medicaid
3. Medicaid Managed Care - Medicaid beneficiaries are required to
select and enroll in a managed care plan.
4. Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs -
correct answer ✅-Demographics
-Chronic Conditions
-Provider payment systems - Provider payment systems that are
designed to reward volume rather than quality, outcomes, and
prevention
