HFMA CSAF EXAM PAPER 2026
COMPLETE QUESTIONS AND 100%
CORRECT ANSWERS
⫸ DRG is used to classify 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 Answer:
HMO
Conventional
PPO and POS
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:
Answer: Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
⫸ Identify the various types of government‐sponsored health coverage:
Answer: Medicare - Government; Beneficiaries enrolled in such plans,
but, participation in these
, plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select
and enroll in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
⫸ Identify some key drivers of increasing healthcare costs Answer:
Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are designed
to reward volume rather than quality, outcomes, and prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
⫸ Health Maintenance Organizations (HMO) Answer: Referrals
PCP
Patients must use an in-network provider for their services to be
covered.
Reimbursement - majority of services offered are reimbursed through
capitation payments (PMPM)
COMPLETE QUESTIONS AND 100%
CORRECT ANSWERS
⫸ DRG is used to classify 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 Answer:
HMO
Conventional
PPO and POS
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:
Answer: Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
⫸ Identify the various types of government‐sponsored health coverage:
Answer: Medicare - Government; Beneficiaries enrolled in such plans,
but, participation in these
, plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select
and enroll in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
⫸ Identify some key drivers of increasing healthcare costs Answer:
Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are designed
to reward volume rather than quality, outcomes, and prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
⫸ Health Maintenance Organizations (HMO) Answer: Referrals
PCP
Patients must use an in-network provider for their services to be
covered.
Reimbursement - majority of services offered are reimbursed through
capitation payments (PMPM)
