CSPR HFMA REVIEWS QUESTIONS AND ANSWERS
SURE A+
✔✔Which option is considered a key difference between inpatient and outpatient
contracting? -✔✔-Reimbursement methodology differences
-Operational policies and procedures
-Market differences affecting outpatient and inpatient volumes
✔✔All of the following should be analyzed prior to and/or during contract negotiations,
EXCEPT: -✔✔Historical member premiums
✔✔All of the following should be analyzed prior to and/or during contract negotiations: -
✔✔-Member volumes by product type
-Historical reimbursement levels by product type
-Historical claims payment and/or submission problems
✔✔What is a clean claim? -✔✔A properly completed billing form
✔✔Which data is included in a termination provision in standard contracting? -✔✔-What
is cause?
-What is termination Without Cause?
-Notice of termination
✔✔What is direct contracting? -✔✔A single-employer or multi-employer healthcare
alliances that contract directly with providers for healthcare services
✔✔What is a non-directed PPO? -✔✔A payer that has contracted either directly or
indirectly with the provider to access preferred rates
✔✔All of the following are responsibilities of a provider organization's Board of
Directors, EXCEPT: -✔✔Implementation issues
, ✔✔All of the following are responsibilities of a provider organization's Board of
Directors: -✔✔-Fiduciary matters
-Legal affairs
-Policy matters
✔✔Which of the following is required for claims processing? -✔✔-Patient and/or
enrollee ID, age, and gender
-Type of diagnosis/major diagnostic category
-Date of service
✔✔Which of the following terms refers to information about any other health plan or
carrier that may share liability for healthcare expenses via a spouse's coverage or the
like? -✔✔Coordination of benefits (COB)
✔✔What is the function of electronic data interchange (EDI)? -✔✔To allow both
healthcare providers and payers to exchange common information required
✔✔What was the aim of advocacy groups initiated in the late 1990s? -✔✔To inform the
discussion about the quality of care and the value of benefit plans
✔✔Which of the following statements is true regarding The Leapfrog Group? -✔✔The
Leapfrog Group was started in the late 1990s to engage consumers and clinicians in the
discussion to improve care quality.
✔✔Which option is included in the set of new value propositions and tools that emerged
in the early 2000s? -✔✔-Product development focused on employee contribution
strategies, network access, and funding options.
-Medical management philosophies based on retrospective evaluation of care, rather
than prospective review and management.
-A proliferation of self-service technologies to reduce administrative costs.
✔✔Identify which option(s) is a benefit for CDHP consumers. -✔✔-Coverage
-Choice
-Access
✔✔Identify which options are a benefit for HSA consumers. -✔✔-It is transportable,
allowing workers access from one job to the next.
-Both employees and employers can contribute pretax dollars to the qualified account.
-They are available to everyone, not just employees of small businesses or the self-
employed.
✔✔What is an ACO? -✔✔A system of providers and facilities that can work in concert to
care for a given patient population
SURE A+
✔✔Which option is considered a key difference between inpatient and outpatient
contracting? -✔✔-Reimbursement methodology differences
-Operational policies and procedures
-Market differences affecting outpatient and inpatient volumes
✔✔All of the following should be analyzed prior to and/or during contract negotiations,
EXCEPT: -✔✔Historical member premiums
✔✔All of the following should be analyzed prior to and/or during contract negotiations: -
✔✔-Member volumes by product type
-Historical reimbursement levels by product type
-Historical claims payment and/or submission problems
✔✔What is a clean claim? -✔✔A properly completed billing form
✔✔Which data is included in a termination provision in standard contracting? -✔✔-What
is cause?
-What is termination Without Cause?
-Notice of termination
✔✔What is direct contracting? -✔✔A single-employer or multi-employer healthcare
alliances that contract directly with providers for healthcare services
✔✔What is a non-directed PPO? -✔✔A payer that has contracted either directly or
indirectly with the provider to access preferred rates
✔✔All of the following are responsibilities of a provider organization's Board of
Directors, EXCEPT: -✔✔Implementation issues
, ✔✔All of the following are responsibilities of a provider organization's Board of
Directors: -✔✔-Fiduciary matters
-Legal affairs
-Policy matters
✔✔Which of the following is required for claims processing? -✔✔-Patient and/or
enrollee ID, age, and gender
-Type of diagnosis/major diagnostic category
-Date of service
✔✔Which of the following terms refers to information about any other health plan or
carrier that may share liability for healthcare expenses via a spouse's coverage or the
like? -✔✔Coordination of benefits (COB)
✔✔What is the function of electronic data interchange (EDI)? -✔✔To allow both
healthcare providers and payers to exchange common information required
✔✔What was the aim of advocacy groups initiated in the late 1990s? -✔✔To inform the
discussion about the quality of care and the value of benefit plans
✔✔Which of the following statements is true regarding The Leapfrog Group? -✔✔The
Leapfrog Group was started in the late 1990s to engage consumers and clinicians in the
discussion to improve care quality.
✔✔Which option is included in the set of new value propositions and tools that emerged
in the early 2000s? -✔✔-Product development focused on employee contribution
strategies, network access, and funding options.
-Medical management philosophies based on retrospective evaluation of care, rather
than prospective review and management.
-A proliferation of self-service technologies to reduce administrative costs.
✔✔Identify which option(s) is a benefit for CDHP consumers. -✔✔-Coverage
-Choice
-Access
✔✔Identify which options are a benefit for HSA consumers. -✔✔-It is transportable,
allowing workers access from one job to the next.
-Both employees and employers can contribute pretax dollars to the qualified account.
-They are available to everyone, not just employees of small businesses or the self-
employed.
✔✔What is an ACO? -✔✔A system of providers and facilities that can work in concert to
care for a given patient population
