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CSPR - Certified Specialist Payment Rep (HFMA)
Exam Actual Complete Real Verified Exam Questions
And Correct Answers (Verified Answers) Already
Graded A+ || Newest Exam!!!
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.
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Reimbursement - majority of services offered are
reimbursed through capitation payments (PMPM)
Medicare is composed of four parts: - Answer-Part A -
provides inpatient/hospital, hospice, and skilled nursing
coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare
benefits (known as Medicare
Advantage)
Part D - prescription drug coverage
HMO Act of 1973 - Answer-The HMO Act of 1973 gave
federally qualified HMOs the right to mandate that
employers offer their product to their employees under
certain conditions. Mandating an employer meant that
employers who had 25 or more employees and were for‐
profit companies were required to make a dual choice
available to their employees.
Which of the following statements regarding employer-
based health insurance in the United States is true? -
Answer-The real advent of employer-based insurance
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came through Blue Cross, which was started by hospital
associations during the Depression.
The Health Maintenance Organization (HMO) Act of 1973
gave qualified HMOs the right to "mandate" an employer
under certain conditions, meaning employers: - Answer-
Would have to offer HMO plans along side traditional fee-
for-service medical plans.
Which of the following is an anticipated change in the
relationships between consumers and providers? -
Answer-Providers will face many new service demands
and consumers will have virtually unfettered access to
those services
What transition began as a result of the March 2010
healthcare reform legislation? - Answer-A transition toward
new models of health care delivery with corresponding
changes system financing and provider reimbursement.
Which statement is false concerning ABNs? - Answer-ABN
began establishing new requirements for managed care
plans participating in the Medicare program.
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Which Statement is TRUE concerning ABNs? - Answer--
ABNs are not required for services that are never covered
by Medicare.
-An ABN form notifies the patient before he or she
receives the service that it may not be
covered by Medicare and that he or she will need to pay
out of pocket.
-Although ABNs can have significant financial implications
for the physician, they also
serve an important fraud and abuse compliance function.
Steps used to control costs of managed care include: -
Answer-Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
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
CSPR - Certified Specialist Payment Rep (HFMA)
Exam Actual Complete Real Verified Exam Questions
And Correct Answers (Verified Answers) Already
Graded A+ || Newest Exam!!!
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.
,2|Page
Reimbursement - majority of services offered are
reimbursed through capitation payments (PMPM)
Medicare is composed of four parts: - Answer-Part A -
provides inpatient/hospital, hospice, and skilled nursing
coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare
benefits (known as Medicare
Advantage)
Part D - prescription drug coverage
HMO Act of 1973 - Answer-The HMO Act of 1973 gave
federally qualified HMOs the right to mandate that
employers offer their product to their employees under
certain conditions. Mandating an employer meant that
employers who had 25 or more employees and were for‐
profit companies were required to make a dual choice
available to their employees.
Which of the following statements regarding employer-
based health insurance in the United States is true? -
Answer-The real advent of employer-based insurance
,3|Page
came through Blue Cross, which was started by hospital
associations during the Depression.
The Health Maintenance Organization (HMO) Act of 1973
gave qualified HMOs the right to "mandate" an employer
under certain conditions, meaning employers: - Answer-
Would have to offer HMO plans along side traditional fee-
for-service medical plans.
Which of the following is an anticipated change in the
relationships between consumers and providers? -
Answer-Providers will face many new service demands
and consumers will have virtually unfettered access to
those services
What transition began as a result of the March 2010
healthcare reform legislation? - Answer-A transition toward
new models of health care delivery with corresponding
changes system financing and provider reimbursement.
Which statement is false concerning ABNs? - Answer-ABN
began establishing new requirements for managed care
plans participating in the Medicare program.
, 4|Page
Which Statement is TRUE concerning ABNs? - Answer--
ABNs are not required for services that are never covered
by Medicare.
-An ABN form notifies the patient before he or she
receives the service that it may not be
covered by Medicare and that he or she will need to pay
out of pocket.
-Although ABNs can have significant financial implications
for the physician, they also
serve an important fraud and abuse compliance function.
Steps used to control costs of managed care include: -
Answer-Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
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
