CSPR - Certified Specialist Payment Rep
(HFMA) QUESTIONS AND ANSWERS
1. DRG is used to categorise - ANS-Inpatient admissions for the motive of reimbursing
hospitals for each case in a given category w/a negotiated fixed rate, irrespective
of the real fees incurred
2. Health Maintenance Organizations (HMO) - ANS-Referrals
PCP
Patients should use an in-community company for their services to be blanketed.
Reimbursement - majority of services presented are reimbursed through
capitation bills (PMPM)
All of the above
HMO Act of 1973 - ANS-The HMO Act of 1973 gave federally qualified HMOs the
right to mandate that employers offer their product to their personnel under
certain situations. Mandating an business enterprise supposed that employers
who had 25 or greater personnel and had been for‐income companies have been
required to make a dual preference available to their employees.
3. Identify some key drivers of growing healthcare charges - ANS-Demographics
Chronic Conditions
Provider fee systems - Provider payment structures which are designed to reward
volume instead of fine, outcomes, and prevention
Consumer Perceptions
Health Plan stress
Physician Relationships
Supply Chain
All of the above
4. Identify the diverse varieties of government‐backed fitness coverage: - ANS-Medicare -
Government; Beneficiaries enrolled in such plans, but, participation in those
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to pick and enroll in
a controlled care plan.
Medicare Managed Care (a.K.A. Medicare Advantage Plans)
All of the above
5. Identify the numerous styles of private fitness plan insurance - ANS-HMO
Conventional
PPO and POS
HDHP/SO plans - excessive-deductible fitness plans with a savings choice; Private
- Include higher affected person out-of-pocket prices for treatments that could
serve to reduce usage/charges.
All of the above
(HFMA) QUESTIONS AND ANSWERS
1. DRG is used to categorise - ANS-Inpatient admissions for the motive of reimbursing
hospitals for each case in a given category w/a negotiated fixed rate, irrespective
of the real fees incurred
2. Health Maintenance Organizations (HMO) - ANS-Referrals
PCP
Patients should use an in-community company for their services to be blanketed.
Reimbursement - majority of services presented are reimbursed through
capitation bills (PMPM)
All of the above
HMO Act of 1973 - ANS-The HMO Act of 1973 gave federally qualified HMOs the
right to mandate that employers offer their product to their personnel under
certain situations. Mandating an business enterprise supposed that employers
who had 25 or greater personnel and had been for‐income companies have been
required to make a dual preference available to their employees.
3. Identify some key drivers of growing healthcare charges - ANS-Demographics
Chronic Conditions
Provider fee systems - Provider payment structures which are designed to reward
volume instead of fine, outcomes, and prevention
Consumer Perceptions
Health Plan stress
Physician Relationships
Supply Chain
All of the above
4. Identify the diverse varieties of government‐backed fitness coverage: - ANS-Medicare -
Government; Beneficiaries enrolled in such plans, but, participation in those
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to pick and enroll in
a controlled care plan.
Medicare Managed Care (a.K.A. Medicare Advantage Plans)
All of the above
5. Identify the numerous styles of private fitness plan insurance - ANS-HMO
Conventional
PPO and POS
HDHP/SO plans - excessive-deductible fitness plans with a savings choice; Private
- Include higher affected person out-of-pocket prices for treatments that could
serve to reduce usage/charges.
All of the above
