HFMA CSPR
Course 4
Comprehensive
Final Exam Review
Q&A
2024
,1. Which of the following is NOT a typical reimbursement methodology
used in managed care?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: d) Retrospective payment
Rationale: Retrospective payment is not a typical reimbursement
methodology used in managed care. It involves paying providers after
services have been delivered, rather than in advance or on a per-member
basis.
2. In capitation, providers are paid a fixed amount per member per:
a) Day
b) Week
c) Month
d) Year
Answer: c) Month
Rationale: Capitation involves providers being paid a fixed amount per
member per month, regardless of the services rendered.
3. Which reimbursement methodology incentivizes providers to deliver
care efficiently and cost-effectively?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: b) Capitation
Rationale: Capitation incentivizes providers to deliver care efficiently and
cost-effectively, as they are paid a fixed amount per member per month
regardless of the services provided.
4. Bundled payments involve paying providers a single predetermined
amount for:
, a) Each individual service provided
b) All services associated with a specific episode of care
c) Services provided within a certain time frame
d) All services provided in a given year
Answer: b) All services associated with a specific episode of care
Rationale: Bundled payments involve paying providers a single
predetermined amount for all services associated with a specific episode
of care, rather than on a fee-for-service basis.
5. Which reimbursement methodology requires providers to submit claims
for each individual service provided?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: a) Fee-for-service
Rationale: Fee-for-service reimbursement requires providers to submit
claims for each individual service provided, typically resulting in higher
costs and more fragmented care.
6. Which reimbursement methodology is commonly used in Medicare
Advantage plans?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: b) Capitation
Rationale: Capitation is commonly used in Medicare Advantage plans,
where providers are paid a fixed amount per member per month.
7. Which of the following reimbursement methodologies focuses on
quality rather than quantity of services provided?
a) Fee-for-service
b) Capitation
c) Bundled payments
Course 4
Comprehensive
Final Exam Review
Q&A
2024
,1. Which of the following is NOT a typical reimbursement methodology
used in managed care?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: d) Retrospective payment
Rationale: Retrospective payment is not a typical reimbursement
methodology used in managed care. It involves paying providers after
services have been delivered, rather than in advance or on a per-member
basis.
2. In capitation, providers are paid a fixed amount per member per:
a) Day
b) Week
c) Month
d) Year
Answer: c) Month
Rationale: Capitation involves providers being paid a fixed amount per
member per month, regardless of the services rendered.
3. Which reimbursement methodology incentivizes providers to deliver
care efficiently and cost-effectively?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: b) Capitation
Rationale: Capitation incentivizes providers to deliver care efficiently and
cost-effectively, as they are paid a fixed amount per member per month
regardless of the services provided.
4. Bundled payments involve paying providers a single predetermined
amount for:
, a) Each individual service provided
b) All services associated with a specific episode of care
c) Services provided within a certain time frame
d) All services provided in a given year
Answer: b) All services associated with a specific episode of care
Rationale: Bundled payments involve paying providers a single
predetermined amount for all services associated with a specific episode
of care, rather than on a fee-for-service basis.
5. Which reimbursement methodology requires providers to submit claims
for each individual service provided?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: a) Fee-for-service
Rationale: Fee-for-service reimbursement requires providers to submit
claims for each individual service provided, typically resulting in higher
costs and more fragmented care.
6. Which reimbursement methodology is commonly used in Medicare
Advantage plans?
a) Fee-for-service
b) Capitation
c) Bundled payments
d) Retrospective payment
Answer: b) Capitation
Rationale: Capitation is commonly used in Medicare Advantage plans,
where providers are paid a fixed amount per member per month.
7. Which of the following reimbursement methodologies focuses on
quality rather than quantity of services provided?
a) Fee-for-service
b) Capitation
c) Bundled payments
