CSBI HFMA 2026 EXAM REVIEW PACK
FULLY SOLVED QUESTIONS
◉What are rating tiers?. Answer: Different rates charged on the
basis of the number and relationships
◉What is the role of reinsurance?. Answer: Reinsurance seeks to
limit a policyholder's liability for catastrophic claims
◉Which option is a major trend in case management?. Answer: -
Shift from broad-based toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
◉What type of provider authorization is applied in emergency
cases, where prior authorization is impossible?. Answer: Concurrent
◉What is utilization management (UM)?. Answer: A tool to control
the costs of providing healthcare services to enrollees
, ◉Which of the following statements is true about disease
management (DM)?. Answer: DM programs encourage patients to
assume some control over their disease state
◉What is the function of catastrophic case management (CM)?.
Answer: It is used to manage diseases in patients with very high
costs of care.
◉What is demand management?. Answer: A coordinated effort by
the MCO, employers, and providers to control the utilization of
medical services and resources
◉All of the following are effective contract evaluation criteria,
EXCEPT:. Answer: Detailed contract performance assessments
◉All of the following are effective contract evaluation criteria:.
Answer: -General payer or provider criteria
-Reimbursement levels and parameters
-Provider costs and responsibilities
◉The following are tools for optimizing contract performance,
EXCEPT:. Answer: Contract language
FULLY SOLVED QUESTIONS
◉What are rating tiers?. Answer: Different rates charged on the
basis of the number and relationships
◉What is the role of reinsurance?. Answer: Reinsurance seeks to
limit a policyholder's liability for catastrophic claims
◉Which option is a major trend in case management?. Answer: -
Shift from broad-based toward more focused efforts
-Reduction of administrative costs
-Greater physician involvement
◉What type of provider authorization is applied in emergency
cases, where prior authorization is impossible?. Answer: Concurrent
◉What is utilization management (UM)?. Answer: A tool to control
the costs of providing healthcare services to enrollees
, ◉Which of the following statements is true about disease
management (DM)?. Answer: DM programs encourage patients to
assume some control over their disease state
◉What is the function of catastrophic case management (CM)?.
Answer: It is used to manage diseases in patients with very high
costs of care.
◉What is demand management?. Answer: A coordinated effort by
the MCO, employers, and providers to control the utilization of
medical services and resources
◉All of the following are effective contract evaluation criteria,
EXCEPT:. Answer: Detailed contract performance assessments
◉All of the following are effective contract evaluation criteria:.
Answer: -General payer or provider criteria
-Reimbursement levels and parameters
-Provider costs and responsibilities
◉The following are tools for optimizing contract performance,
EXCEPT:. Answer: Contract language
