HFMA Certified Specialist Payment
& Reimbursement (CSPR) Exam
Guide (Latest Update )
Full Course Questions & Answers |
Grade A | 100% Correct (Verified
Solutions)
Question:
claims adjudication
Answer:
Term used in the insurance industry for the process of paying or denying
claims based on the patient's plan/coverage
Question:
Patient Bill of Rights
Answer:
Established in 1973, a list of rights that are designed to protect both the
patient and HCP
,Question:
Leapfrog Group
Answer:
Organization that promotes healthcare safety by giving consumers the
information they need to make better-informed choices about the hospitals
they choose
Question:
HSA -health savings account
Answer:
An account used in association with a medical plan that carries a high
deductible
Question:
ACO Benefits
Answer:
A system of providers and facilities that can work in concert to care for a given
patient population.
,Question:
Healthcare Report Cards groups
Answer:
Required National Performance Measurement Reporting Initiatives,
Voluntary National Performance Measurement Reporting Initiatives,
Employer Coalition Performance Measure Reporting Initiatives.
Question:
COBRA (Consolidated Omnibus Budget Reconciliation Act)
Answer:
Provides certain former employees, retirees, spouses, former spouses, and
dependent children the right to temporary continuation of health coverage at
group rates. 60 Days
Question:
EMTALA (Emergency Medical Treatment and Active Labor Act)
Answer:
Governs when and how a patient presenting at a hospital may be refused
treatment or may be transferred from one hospital to another when in an
unstable condition
, Question:
URAC (Utilization Review Accreditation Commission)
Answer:
This independent, nonprofit organization, since 1991 through the beginning
of 1996, has offered a specialty accreditation program for utilization review
functions.
Question:
Recovery Audit Contractor (RAC)
Answer:
A 3rd-party entity working under the direction of CMS to detect improper
Medicare payments through review of providers' medical records an Medicare
claims data
Question:
DNV GL
Answer:
Accreditation utilizing the ISO 9001 quality management system that
emphasizes continual improvement and requires an annual onsite survey. A
hospital must be certified to the ISO 9001 requirements within two years of its
initial accreditation.
& Reimbursement (CSPR) Exam
Guide (Latest Update )
Full Course Questions & Answers |
Grade A | 100% Correct (Verified
Solutions)
Question:
claims adjudication
Answer:
Term used in the insurance industry for the process of paying or denying
claims based on the patient's plan/coverage
Question:
Patient Bill of Rights
Answer:
Established in 1973, a list of rights that are designed to protect both the
patient and HCP
,Question:
Leapfrog Group
Answer:
Organization that promotes healthcare safety by giving consumers the
information they need to make better-informed choices about the hospitals
they choose
Question:
HSA -health savings account
Answer:
An account used in association with a medical plan that carries a high
deductible
Question:
ACO Benefits
Answer:
A system of providers and facilities that can work in concert to care for a given
patient population.
,Question:
Healthcare Report Cards groups
Answer:
Required National Performance Measurement Reporting Initiatives,
Voluntary National Performance Measurement Reporting Initiatives,
Employer Coalition Performance Measure Reporting Initiatives.
Question:
COBRA (Consolidated Omnibus Budget Reconciliation Act)
Answer:
Provides certain former employees, retirees, spouses, former spouses, and
dependent children the right to temporary continuation of health coverage at
group rates. 60 Days
Question:
EMTALA (Emergency Medical Treatment and Active Labor Act)
Answer:
Governs when and how a patient presenting at a hospital may be refused
treatment or may be transferred from one hospital to another when in an
unstable condition
, Question:
URAC (Utilization Review Accreditation Commission)
Answer:
This independent, nonprofit organization, since 1991 through the beginning
of 1996, has offered a specialty accreditation program for utilization review
functions.
Question:
Recovery Audit Contractor (RAC)
Answer:
A 3rd-party entity working under the direction of CMS to detect improper
Medicare payments through review of providers' medical records an Medicare
claims data
Question:
DNV GL
Answer:
Accreditation utilizing the ISO 9001 quality management system that
emphasizes continual improvement and requires an annual onsite survey. A
hospital must be certified to the ISO 9001 requirements within two years of its
initial accreditation.
