HFMA CSPR EXAM QUESTIONS WITH
CORRECT SOLUTIONS||100%
GUARANTEED PASS||UPDATED
2026/2027 SYLLABUS||ALREADY
GRADED A+||<<LATEST VERSION>>
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:
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
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
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
B) ERISA
C) COBRA
D) EMTALA - ANSWER ✓ A) URAC
Hospitals, health systems, and large physician groups are likely to have robust
governance models models with supporting organizational infrastructure to oversee
and carry out managed care operations. Small Physician groups could have all of
the following, EXCEPT:
A) Relationships with large provider organizations to share managed care
operations
B) Outsource managed care operations
C) Similar operations only for chargemaster price estimation
D) Reliance on a core set of individuals to direct and administer managed care
operations - ANSWER ✓ C) Similar operations only for chargemaster price
estimation
The law that encompasses all health benefit issues of a self-funded health
insurance plan, including administrator competence, is called the:
A) HMO Act
B) Employee Self-Funded Plan Act (ESPA)
C) Employee Retirement Income Security Act (ERISA)
CORRECT SOLUTIONS||100%
GUARANTEED PASS||UPDATED
2026/2027 SYLLABUS||ALREADY
GRADED A+||<<LATEST VERSION>>
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:
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
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
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
B) ERISA
C) COBRA
D) EMTALA - ANSWER ✓ A) URAC
Hospitals, health systems, and large physician groups are likely to have robust
governance models models with supporting organizational infrastructure to oversee
and carry out managed care operations. Small Physician groups could have all of
the following, EXCEPT:
A) Relationships with large provider organizations to share managed care
operations
B) Outsource managed care operations
C) Similar operations only for chargemaster price estimation
D) Reliance on a core set of individuals to direct and administer managed care
operations - ANSWER ✓ C) Similar operations only for chargemaster price
estimation
The law that encompasses all health benefit issues of a self-funded health
insurance plan, including administrator competence, is called the:
A) HMO Act
B) Employee Self-Funded Plan Act (ESPA)
C) Employee Retirement Income Security Act (ERISA)
