CSPR 100 2026 COMPLETE STERILE
PROCESSING TECHNICIAN EXAM
PREPARATION AND PRACTICE NOTES
◉ What are the four main types of Managed Care Organizations
(MCOs)?
Answer: Health Maintenance Organizations (HMOs), Preferred
Provider Organizations (PPOs), Point-of-Service (POS) plans, and
Exclusive Provider Organizations (EPOs).
◉ How do Health Maintenance Organizations (HMOs) operate?
Answer: HMOs act as both insurer and provider, requiring patients
to use in-network providers for coverage and typically pay through
capitation.
◉ What is a key feature of Preferred Provider Organizations (PPOs)?
Answer: PPOs offer more flexibility with a broad provider network
and allow enrollees to self-refer to providers.
◉ What distinguishes Point-of-Service (POS) plans from HMOs and
PPOs?
,Answer: POS plans blend features of HMOs and PPOs, requiring
members to select a primary care provider but allowing self-
referrals to specialists in-network.
◉ What is the coverage limitation of Exclusive Provider
Organizations (EPOs)?
Answer: EPO coverage applies only when using in-network
providers, except in emergencies.
◉ What was the predominant form of health insurance coverage
before managed care?
Answer: Conventional or indemnity health insurance coverage.
◉ What changes were introduced in health plan products in
response to rising healthcare costs?
Answer: Incentives and restrictions designed to influence treatment
decisions and constrain costs, including financial incentives and
treatment protocols.
◉ What are Accountable Care Organizations (ACOs)?
Answer: Organizations formed by providers to coordinate and
improve the quality and cost of care while accepting financial risk
for their performance.
,◉ What is a Third Party Administrator (TPA)?
Answer: A firm that performs administrative functions for a self-
funded plan, such as claims processing and membership
management.
◉ What is an Administrative Service Organization (ASO)?
Answer: A contract where an insurance company or health plan
administrator performs administrative functions without assuming
risk.
◉ What historical event marked the beginning of employer-funded
medical programs?
Answer: The late 1800s when companies created medical plans for
workers and their families.
◉ What was the significance of Blue Cross during the Great
Depression?
Answer: It allowed for easier access to health coverage through
payroll deductions, marking the advent of employer-based
insurance.
◉ What major healthcare programs were introduced in 1965?
Answer: Medicare and Medicaid, which revolutionized access to
healthcare for older adults and low-income families.
, ◉ What did the Health Maintenance Organization Act of 1973
accomplish?
Answer: It allowed federally qualified HMOs to require employers to
offer an HMO option alongside traditional fee-for-service plans.
◉ What are high-deductible health plans with health savings
accounts designed to do?
Answer: Shift more cost responsibility to consumers while
increasing transparency in healthcare spending.
◉ What impact did the Affordable Care Act of 2010 have on
healthcare delivery?
Answer: It promoted new models of care delivery, bundled
payments, and accountable care organizations that reward providers
for quality.
◉ What is the patient-centered medical approach?
Answer: An approach emphasizing team-based continuous care to
reduce emergency room visits and hospital readmissions.
◉ What is the current trend in managed care?
Answer: Better coordination, smarter spending, and improved
quality of care through integrated delivery systems.
PROCESSING TECHNICIAN EXAM
PREPARATION AND PRACTICE NOTES
◉ What are the four main types of Managed Care Organizations
(MCOs)?
Answer: Health Maintenance Organizations (HMOs), Preferred
Provider Organizations (PPOs), Point-of-Service (POS) plans, and
Exclusive Provider Organizations (EPOs).
◉ How do Health Maintenance Organizations (HMOs) operate?
Answer: HMOs act as both insurer and provider, requiring patients
to use in-network providers for coverage and typically pay through
capitation.
◉ What is a key feature of Preferred Provider Organizations (PPOs)?
Answer: PPOs offer more flexibility with a broad provider network
and allow enrollees to self-refer to providers.
◉ What distinguishes Point-of-Service (POS) plans from HMOs and
PPOs?
,Answer: POS plans blend features of HMOs and PPOs, requiring
members to select a primary care provider but allowing self-
referrals to specialists in-network.
◉ What is the coverage limitation of Exclusive Provider
Organizations (EPOs)?
Answer: EPO coverage applies only when using in-network
providers, except in emergencies.
◉ What was the predominant form of health insurance coverage
before managed care?
Answer: Conventional or indemnity health insurance coverage.
◉ What changes were introduced in health plan products in
response to rising healthcare costs?
Answer: Incentives and restrictions designed to influence treatment
decisions and constrain costs, including financial incentives and
treatment protocols.
◉ What are Accountable Care Organizations (ACOs)?
Answer: Organizations formed by providers to coordinate and
improve the quality and cost of care while accepting financial risk
for their performance.
,◉ What is a Third Party Administrator (TPA)?
Answer: A firm that performs administrative functions for a self-
funded plan, such as claims processing and membership
management.
◉ What is an Administrative Service Organization (ASO)?
Answer: A contract where an insurance company or health plan
administrator performs administrative functions without assuming
risk.
◉ What historical event marked the beginning of employer-funded
medical programs?
Answer: The late 1800s when companies created medical plans for
workers and their families.
◉ What was the significance of Blue Cross during the Great
Depression?
Answer: It allowed for easier access to health coverage through
payroll deductions, marking the advent of employer-based
insurance.
◉ What major healthcare programs were introduced in 1965?
Answer: Medicare and Medicaid, which revolutionized access to
healthcare for older adults and low-income families.
, ◉ What did the Health Maintenance Organization Act of 1973
accomplish?
Answer: It allowed federally qualified HMOs to require employers to
offer an HMO option alongside traditional fee-for-service plans.
◉ What are high-deductible health plans with health savings
accounts designed to do?
Answer: Shift more cost responsibility to consumers while
increasing transparency in healthcare spending.
◉ What impact did the Affordable Care Act of 2010 have on
healthcare delivery?
Answer: It promoted new models of care delivery, bundled
payments, and accountable care organizations that reward providers
for quality.
◉ What is the patient-centered medical approach?
Answer: An approach emphasizing team-based continuous care to
reduce emergency room visits and hospital readmissions.
◉ What is the current trend in managed care?
Answer: Better coordination, smarter spending, and improved
quality of care through integrated delivery systems.
