CSPR CERTIFIED SPECIALIST PAYMENT REP HFMA ACTUAL EXAM
NEWEST 2025 COMPLETE 200 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND
NEW VERSION!!
Steps used to control costs of managed care include: - (Correct Answer)Bundled
codes
Capitation
Payer and Provider to agree on reasonable payment
心的坚强决定了我们的命运。当
我们面对挫折时，是一颗不屈的
DRG is used to classify - (Correct Answer)Inpatient admissions for the purpose of
心让我们勇敢前行
reimbursing hospitals for each case in a given category w/a negotiated fixed fee,
regardless of the actual costs incurred
Identify the various types of private health plan coverage - (Correct Answer)HMO
Conventional
PPO and POS
,HDHP/SO plans - high-deductible health plans with a savings option; Private -
Include higher patient out-of-pocket expenditures for treatments that can serve to
reduce utilization/costs.
Managed care organizations (MCO) exist primarily in four forms: - (Correct
Answer)Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
心的坚强决定了我们的命运。当
Exclusive Provider Organizations (EPO)
我们面对挫折时，是一颗不屈的
心让我们勇敢前行
Identify the various types of government‐sponsored health coverage: - (Correct
Answer)Medicare - Government; Beneficiaries enrolled in such plans, but,
participation in these
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select and enroll
in a managed care plan.
,Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs - (Correct
Answer)Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are designed to reward
volume rather than quality, outcomes, and prevention
Consumer Perceptions
心的坚强决定了我们的命运。当
Health Plan pressure 我们面对挫折时，是一颗不屈的
心让我们勇敢前行
Physician Relationships
Supply Chain
Health Maintenance Organizations (HMO) - (Correct Answer)Referrals
PCP
Patients must use an in-network provider for their services to be covered.
Reimbursement - majority of services offered are reimbursed through capitation
payments (PMPM)
, Medicare is composed of four parts: - (Correct Answer)Part A - provides
inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare benefits (known as Medicare
Advantage)
Part D - prescription drug coverage
心的坚强决定了我们的命运。当
HMO Act of 1973 - (Correct 我们面对挫折时，是一颗不屈的
Answer)The HMO Act of 1973 gave federally
心让我们勇敢前行
qualified HMOs the right to mandate that employers offer their product to their
employees under certain conditions. Mandating an employer meant that employers
who had 25 or more employees and were for‐profit companies were required to
make a dual choice available to their employees.
Which of the following statements regarding employer-based health insurance in
the United States is true? - (Correct Answer)The real advent of employer-based
insurance came through Blue Cross, which was started by hospital associations
during the Depression.
NEWEST 2025 COMPLETE 200 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND
NEW VERSION!!
Steps used to control costs of managed care include: - (Correct Answer)Bundled
codes
Capitation
Payer and Provider to agree on reasonable payment
心的坚强决定了我们的命运。当
我们面对挫折时，是一颗不屈的
DRG is used to classify - (Correct Answer)Inpatient admissions for the purpose of
心让我们勇敢前行
reimbursing hospitals for each case in a given category w/a negotiated fixed fee,
regardless of the actual costs incurred
Identify the various types of private health plan coverage - (Correct Answer)HMO
Conventional
PPO and POS
,HDHP/SO plans - high-deductible health plans with a savings option; Private -
Include higher patient out-of-pocket expenditures for treatments that can serve to
reduce utilization/costs.
Managed care organizations (MCO) exist primarily in four forms: - (Correct
Answer)Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
心的坚强决定了我们的命运。当
Exclusive Provider Organizations (EPO)
我们面对挫折时，是一颗不屈的
心让我们勇敢前行
Identify the various types of government‐sponsored health coverage: - (Correct
Answer)Medicare - Government; Beneficiaries enrolled in such plans, but,
participation in these
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select and enroll
in a managed care plan.
,Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Identify some key drivers of increasing healthcare costs - (Correct
Answer)Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are designed to reward
volume rather than quality, outcomes, and prevention
Consumer Perceptions
心的坚强决定了我们的命运。当
Health Plan pressure 我们面对挫折时，是一颗不屈的
心让我们勇敢前行
Physician Relationships
Supply Chain
Health Maintenance Organizations (HMO) - (Correct Answer)Referrals
PCP
Patients must use an in-network provider for their services to be covered.
Reimbursement - majority of services offered are reimbursed through capitation
payments (PMPM)
, Medicare is composed of four parts: - (Correct Answer)Part A - provides
inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare benefits (known as Medicare
Advantage)
Part D - prescription drug coverage
心的坚强决定了我们的命运。当
HMO Act of 1973 - (Correct 我们面对挫折时，是一颗不屈的
Answer)The HMO Act of 1973 gave federally
心让我们勇敢前行
qualified HMOs the right to mandate that employers offer their product to their
employees under certain conditions. Mandating an employer meant that employers
who had 25 or more employees and were for‐profit companies were required to
make a dual choice available to their employees.
Which of the following statements regarding employer-based health insurance in
the United States is true? - (Correct Answer)The real advent of employer-based
insurance came through Blue Cross, which was started by hospital associations
during the Depression.
