CSBI HFMA 2026 FINAL PAPER QUESTIONS
AND VERIFIED SOLUTIONS
◉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
◉The following are tools for optimizing contract performance:.
Answer: -Financial and volume analysis models.
-Managed care contract dashboard.
-Detailed contract performance assessments.
,◉Which option is considered a key difference between inpatient and
outpatient contracting?. Answer: -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:. Answer: Historical member
premiums
◉All of the following should be analyzed prior to and/or during
contract negotiations:. Answer: -Member volumes by product type
-Historical reimbursement levels by product type
-Historical claims payment and/or submission problems
◉What is a clean claim?. Answer: A properly completed billing form
◉Which data is included in a termination provision in standard
contracting?. Answer: -What is cause?
-What is termination Without Cause?
-Notice of termination
, ◉What is direct contracting?. Answer: A single-employer or multi-
employer healthcare alliances that contract directly with providers
for healthcare services
◉What is a non-directed PPO?. Answer: 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:. Answer: Implementation issues
◉All of the following are responsibilities of a provider organization's
Board of Directors:. Answer: -Fiduciary matters
-Legal affairs
-Policy matters
◉Which of the following is required for claims processing?. Answer:
-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
AND VERIFIED SOLUTIONS
◉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
◉The following are tools for optimizing contract performance:.
Answer: -Financial and volume analysis models.
-Managed care contract dashboard.
-Detailed contract performance assessments.
,◉Which option is considered a key difference between inpatient and
outpatient contracting?. Answer: -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:. Answer: Historical member
premiums
◉All of the following should be analyzed prior to and/or during
contract negotiations:. Answer: -Member volumes by product type
-Historical reimbursement levels by product type
-Historical claims payment and/or submission problems
◉What is a clean claim?. Answer: A properly completed billing form
◉Which data is included in a termination provision in standard
contracting?. Answer: -What is cause?
-What is termination Without Cause?
-Notice of termination
, ◉What is direct contracting?. Answer: A single-employer or multi-
employer healthcare alliances that contract directly with providers
for healthcare services
◉What is a non-directed PPO?. Answer: 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:. Answer: Implementation issues
◉All of the following are responsibilities of a provider organization's
Board of Directors:. Answer: -Fiduciary matters
-Legal affairs
-Policy matters
◉Which of the following is required for claims processing?. Answer:
-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
