CSPR 100 2026 CENTRAL STERILE
PROCESSING AND INFECTION CONTROL
CORE CONCEPTS REVISION PACKAGE
◉ Which of the following is a service provided by a well-managed
third-party administrator (TPA)?.
Answer: -Administrative
-Utilization review (UR)
-Claims processing
◉ What is tiering?.
Answer: The ranking or classifying of one or more of the provider
delivery system components
◉ Which option is a practice used to control costs of managed care?.
Answer: -Making advance payment to providers for all services
needed to care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment
for each service.
◉ Which option is a risk involved in per diem payments?.
,Answer: -The risk to the insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
◉ Diagnosis-related group (DRG) is:.
Answer: A payment category
◉ How is the term carve-out used when discussing managed care?.
Answer: To refer to specific benefits or services
◉ What is the term Coordination of Benefits (COB)?.
Answer: A term used to describe how payment is coordinated for
patients who have coverage through two insurance policies
◉ Which three components are used to determine the total RVU
value for a service?.
Answer: -Malpractice expense
-Lowest market price for services used
-Medicare discounts
◉ A fixed payment amount based upon the number of members
assigned to a provider, and does not vary based upon the number of
services rendered, is known as:.
,Answer: Capitation
◉ Aligning incentives has come to mean _________..
Answer: The appropriate addition of some risk in the exchange of
health care to a patient for some form of remuneration.
◉ According to MedPAC, which option is a benefit or undesirable
consequence of bundling
payments?.
Answer: -It allows Medicare to pay a set fee per hospitalization
episode.
-It would provide the potential to improve efficiency and quality
-It would lead to underutilization of services
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can help hospitals maintain their margins?.
Answer: Contract standardization
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can NOT help hospitals maintain their
margins?.
Answer: -Pay-for-performance programs
-Health savings accounts
, -Price transparency
◉ Identify which initiatives are focused on in an effort to help
increase an organization's revenue/profit /margins..
Answer: -Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
◉ 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
PROCESSING AND INFECTION CONTROL
CORE CONCEPTS REVISION PACKAGE
◉ Which of the following is a service provided by a well-managed
third-party administrator (TPA)?.
Answer: -Administrative
-Utilization review (UR)
-Claims processing
◉ What is tiering?.
Answer: The ranking or classifying of one or more of the provider
delivery system components
◉ Which option is a practice used to control costs of managed care?.
Answer: -Making advance payment to providers for all services
needed to care for a member
-Combining services provided and bundling the associated charges
-Agreement between the payer and provider on reasonable payment
for each service.
◉ Which option is a risk involved in per diem payments?.
,Answer: -The risk to the insurance company or health plan
-The risk to the hospital
-The risk when embracing per diem payments in complex case
◉ Diagnosis-related group (DRG) is:.
Answer: A payment category
◉ How is the term carve-out used when discussing managed care?.
Answer: To refer to specific benefits or services
◉ What is the term Coordination of Benefits (COB)?.
Answer: A term used to describe how payment is coordinated for
patients who have coverage through two insurance policies
◉ Which three components are used to determine the total RVU
value for a service?.
Answer: -Malpractice expense
-Lowest market price for services used
-Medicare discounts
◉ A fixed payment amount based upon the number of members
assigned to a provider, and does not vary based upon the number of
services rendered, is known as:.
,Answer: Capitation
◉ Aligning incentives has come to mean _________..
Answer: The appropriate addition of some risk in the exchange of
health care to a patient for some form of remuneration.
◉ According to MedPAC, which option is a benefit or undesirable
consequence of bundling
payments?.
Answer: -It allows Medicare to pay a set fee per hospitalization
episode.
-It would provide the potential to improve efficiency and quality
-It would lead to underutilization of services
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can help hospitals maintain their margins?.
Answer: Contract standardization
◉ As the healthcare industry moves to control growth in medical
spending, what initiative can NOT help hospitals maintain their
margins?.
Answer: -Pay-for-performance programs
-Health savings accounts
, -Price transparency
◉ Identify which initiatives are focused on in an effort to help
increase an organization's revenue/profit /margins..
Answer: -Health plan consolidation
-Payment policing and standardization of contract requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
◉ 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
