HFMA
CSPR
LATEST FINAL TEST REVIEW
Q&S
©2024/2025
,1. Which of the following is a primary feature of a Health
Maintenance Organization (HMO)?
- A) High degree of patient choice
- B) Fee-for-service reimbursement
- C) Lower out-of-pocket costs with restricted provider access
- D) No need for referrals to see specialists
- ANS: C
2. What is the primary goal of disease management programs in
managed care?
- A) Reduce the number of times a patient visits the doctor
- B) Improve clinical outcomes while reducing overall
healthcare costs
- C) Limit the availability of high-cost medications
- D) Replace traditional physician-patient relationships
- ANS: B
3. Value-based insurance design focuses on:
- A) Reducing all healthcare costs irrespective of clinical
outcomes
©2024/2025
, - B) Equalizing copayments across all services
- C) Aligning patient’s out-of-pocket costs with the value of
services
- D) Prioritizing low-premium plans for all members
- ANS: C
4. Which type of plan is most likely to offer a wider network of
providers but with higher cost-sharing for out-of-network
services?
- A) HMO
- B) Preferred Provider Organization (PPO)
- C) Exclusive Provider Organization (EPO)
- D) Point of Service Plan (POS)
- ANS: B
5. What financial incentive do Accountable Care Organizations
(ACOs) provide to physicians and hospitals?
- A) Flat rate payment per patient
- B) Bonuses for specializing in certain fields
- C) Shared savings through cost reductions and quality
improvement
- D) Exclusive contracts with insurance providers
©2024/2025
, - ANS: C
### Essentials of Medicare and Medicaid Managed Care
6. Which part of Medicare covers outpatient prescription drugs?
- A) Part A
- B) Part B
- C) Part C
- D) Part D
- ANS: D
7. Dual eligibility refers to individuals who are eligible for
which two types of health coverage?
- A) Medicare and private insurance
- B) Medicare and Medicaid
- C) Medicaid and CHIP
- D) Medicare Advantage and Medigap
- ANS: B
8. Which of the following is a common requirement for
Medicaid Managed Care plans?
©2024/2025
CSPR
LATEST FINAL TEST REVIEW
Q&S
©2024/2025
,1. Which of the following is a primary feature of a Health
Maintenance Organization (HMO)?
- A) High degree of patient choice
- B) Fee-for-service reimbursement
- C) Lower out-of-pocket costs with restricted provider access
- D) No need for referrals to see specialists
- ANS: C
2. What is the primary goal of disease management programs in
managed care?
- A) Reduce the number of times a patient visits the doctor
- B) Improve clinical outcomes while reducing overall
healthcare costs
- C) Limit the availability of high-cost medications
- D) Replace traditional physician-patient relationships
- ANS: B
3. Value-based insurance design focuses on:
- A) Reducing all healthcare costs irrespective of clinical
outcomes
©2024/2025
, - B) Equalizing copayments across all services
- C) Aligning patient’s out-of-pocket costs with the value of
services
- D) Prioritizing low-premium plans for all members
- ANS: C
4. Which type of plan is most likely to offer a wider network of
providers but with higher cost-sharing for out-of-network
services?
- A) HMO
- B) Preferred Provider Organization (PPO)
- C) Exclusive Provider Organization (EPO)
- D) Point of Service Plan (POS)
- ANS: B
5. What financial incentive do Accountable Care Organizations
(ACOs) provide to physicians and hospitals?
- A) Flat rate payment per patient
- B) Bonuses for specializing in certain fields
- C) Shared savings through cost reductions and quality
improvement
- D) Exclusive contracts with insurance providers
©2024/2025
, - ANS: C
### Essentials of Medicare and Medicaid Managed Care
6. Which part of Medicare covers outpatient prescription drugs?
- A) Part A
- B) Part B
- C) Part C
- D) Part D
- ANS: D
7. Dual eligibility refers to individuals who are eligible for
which two types of health coverage?
- A) Medicare and private insurance
- B) Medicare and Medicaid
- C) Medicaid and CHIP
- D) Medicare Advantage and Medigap
- ANS: B
8. Which of the following is a common requirement for
Medicaid Managed Care plans?
©2024/2025
