CSPR - CERTIFIED SPECIALIST PAYMENT REP
(HFMA) LATEST EXAM WITH QUESTIONS AND
CORRECT ANSWERS (100%
CORRECT ANSWERS) CSPR CERTIFICATION EXAM
ANSWERED
(BRAND NEW!!)
Which of the following is not examined in a concurrent utilization
management review?
A) Case management
B) Discharge Planning
C) Physician group
D) Length of stay
C) Physician group
A) Private healthcare coverage which includes higher patient out-of-pocket
expenditures for treatments
All are key objectives of the Patient Protection and Affordable Care
Act, EXCEPT:
A) Eliminate overpayment in Medicare Advantage programs
B) Extend health insurance coverage & Reduce the deficit
C) Address insurance company abuses & Make health insurance more
effective D) Verify information such as malpractice history, and
other basic physician credentials
D) Verify information such as malpractice history, and other basic physician
credentials
Advocates of price transparency argue that disclosing the costs of
healthcare will:
A) Lower consumer health costs by increasing competition among
providers
,B) Confuse patients and disincentivize them to seek healthcare
C) Prevent hospitals from seeking reimbursement to cover cost of
care
D) Conflict with the spirit of privately negotiated contract rates A)
Lower consumer health costs by increasing competition among providers
Direct Contracting is defined as:
A) A payer arrangement that results from an MCO that sells or
rents its PPO provider network to an insurance broker
B) A single-employer or multi-employer healthcare alliance that
contracts directly with providers for healthcare services
C) A third party that contracts with an employer to provide
utilization review, and/or claims processing functions
D) A payer that has contracted either directly or indirectly with the
provider to access preferred rate
B) A single-employer or multi-employer healthcare alliance that contracts
directly with providers for healthcare services
Medical loss ratio (MLR) is a synonymous term for:
A) Medical cost revenue (MCR)
B) Medical cost ratio (MCR)
C) Medical coverage revenue (MCR)
D) Medicaid cost ratio (MCR)
B) Medical cost ratio (MCR)
Key differences to consider between inpatient and outpatient services
when contracting include all of the following EXCEPT:
A) Site of service differentials
B) Payment methodologies
C) Patient experience and satisfaction
D) Operational policies and processes
,C) Patient experience and satisfaction
Which of the following is not an example of an objective criteria set
that may be applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA
C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation
A) Bundled payment
Integrated healthcare delivery systems are most capable of
successfully managing which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation
D) Global
capitation A
clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500
B) A properly completed billing form, UB-04 or CMS 1500
, To ensure that patients have the education, tools, and support they
need to make decisions and participate in their own care is the goal
of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's)
B) A patient-centered medical home (PCMH)
Accountable Care Organizations are designed with the following
criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
D) To increase the use of emergency room services
C) To save money by avoiding unnecessary tests
Which option is NOT a utilization management technique?
A) Retrospective UM Techniques
B) Prospective UM Techniques
C) Reimbursement UM Techniques
D) Concurrent UM Techniques C) Reimbursement UM Techniques
Medicare Part D:
A) Is part of the Medicare policy that provides outpatient
prescription drug coverage
B) Is a type of coverage that typically covers outpatient-type
services and physician services
C) Is a type of coverage intended to cover inpatient hospital care or
skilled nursing facility care
(HFMA) LATEST EXAM WITH QUESTIONS AND
CORRECT ANSWERS (100%
CORRECT ANSWERS) CSPR CERTIFICATION EXAM
ANSWERED
(BRAND NEW!!)
Which of the following is not examined in a concurrent utilization
management review?
A) Case management
B) Discharge Planning
C) Physician group
D) Length of stay
C) Physician group
A) Private healthcare coverage which includes higher patient out-of-pocket
expenditures for treatments
All are key objectives of the Patient Protection and Affordable Care
Act, EXCEPT:
A) Eliminate overpayment in Medicare Advantage programs
B) Extend health insurance coverage & Reduce the deficit
C) Address insurance company abuses & Make health insurance more
effective D) Verify information such as malpractice history, and
other basic physician credentials
D) Verify information such as malpractice history, and other basic physician
credentials
Advocates of price transparency argue that disclosing the costs of
healthcare will:
A) Lower consumer health costs by increasing competition among
providers
,B) Confuse patients and disincentivize them to seek healthcare
C) Prevent hospitals from seeking reimbursement to cover cost of
care
D) Conflict with the spirit of privately negotiated contract rates A)
Lower consumer health costs by increasing competition among providers
Direct Contracting is defined as:
A) A payer arrangement that results from an MCO that sells or
rents its PPO provider network to an insurance broker
B) A single-employer or multi-employer healthcare alliance that
contracts directly with providers for healthcare services
C) A third party that contracts with an employer to provide
utilization review, and/or claims processing functions
D) A payer that has contracted either directly or indirectly with the
provider to access preferred rate
B) A single-employer or multi-employer healthcare alliance that contracts
directly with providers for healthcare services
Medical loss ratio (MLR) is a synonymous term for:
A) Medical cost revenue (MCR)
B) Medical cost ratio (MCR)
C) Medical coverage revenue (MCR)
D) Medicaid cost ratio (MCR)
B) Medical cost ratio (MCR)
Key differences to consider between inpatient and outpatient services
when contracting include all of the following EXCEPT:
A) Site of service differentials
B) Payment methodologies
C) Patient experience and satisfaction
D) Operational policies and processes
,C) Patient experience and satisfaction
Which of the following is not an example of an objective criteria set
that may be applied in utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA
C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation
A) Bundled payment
Integrated healthcare delivery systems are most capable of
successfully managing which type of payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation
D) Global
capitation A
clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500
B) A properly completed billing form, UB-04 or CMS 1500
, To ensure that patients have the education, tools, and support they
need to make decisions and participate in their own care is the goal
of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's)
B) A patient-centered medical home (PCMH)
Accountable Care Organizations are designed with the following
criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
D) To increase the use of emergency room services
C) To save money by avoiding unnecessary tests
Which option is NOT a utilization management technique?
A) Retrospective UM Techniques
B) Prospective UM Techniques
C) Reimbursement UM Techniques
D) Concurrent UM Techniques C) Reimbursement UM Techniques
Medicare Part D:
A) Is part of the Medicare policy that provides outpatient
prescription drug coverage
B) Is a type of coverage that typically covers outpatient-type
services and physician services
C) Is a type of coverage intended to cover inpatient hospital care or
skilled nursing facility care
