HFMA Certified Specialist Payment
& Reimbursement (CSPR) Exam
(Latest Update ) Review
Questions & Answers | Grade A |
100% Correct (Verified Solutions)
Question:
The legislation that governs health benefit plans of self-insured, self-funded
employers in the United States is known as:
A) The Employee Retirement Income Security Act of 1974 (ERISA)
B) Det Norske Veritas
C) The 1986 Consolidated Omnibus Budget Reconciliation Act (COBRA)
D) The Health Maintenance Organization Act of 1973
Answer:
A) The Employee Retirement Income Security Act of 1974 (ERISA)
,Question:
To promote healthcare quality through accreditation and certification
programs, is the purpose of:
A) URAC
B) ERISA
C) COBRA
D) EMTALA
Answer:
A) URAC
Question:
The law that encompasses all health benefit issues of a self-funded health
insurance plan, including administrator competence, is called the:
A) HMO Act
B) Employee Self-Funded Plan Act (ESPA)
C) Employee Retirement Income Security Act (ERISA)
D) Affordable Care Act (ACA)
Answer:
C) Employee Retirement Income Security Act (ERISA)
,Question:
Hospitals, health systems, and large physician groups are likely to have robust
governance models with supporting organizational infrastructure to oversee
and carry out managed care operations. Small Physician groups could have all
of the following, EXCEPT:
A) Relationships with large provider organizations to share managed care
operations
B) Outsource managed care operations
C) Similar operations only for chargemaster price estimation
D) Reliance on a core set of individuals to direct and administer managed care
operations
Answer:
C) Similar operations only for chargemaster price estimation
Question:
The Patient Centered Medical Home model is expected to reduce costs by:
A) All of the above
B) Reducing emergency room visits
C) Reducing inpatient admissions
D) Increasing preventive care
Answer:
A) All of the above
, Question:
One way that the term carve-out is used when discussing managed care is:
A) Referring to benefits that are administered separately from the rest of
Medicaid
B) Referring to specific benefits or services that are administered together
with the rest of managed care plan
C) Referring to a broad range of benefits or services that are administered
separately from the rest of the managed care plan
D) Referring to specific benefits or services that are administered separately
from the rest of the managed care plan
Answer:
D) Referring to specific benefits or services that are administered separately
from the rest of the managed care plan
Question:
The following are quality-related outcomes that can be measured except:
A) Transplant quality indicators
B) Risk-adjusted mortality rates
C) Level of physician compensation
D) Readmission rates
Answer:
C) Level of physician compensation
& Reimbursement (CSPR) Exam
(Latest Update ) Review
Questions & Answers | Grade A |
100% Correct (Verified Solutions)
Question:
The legislation that governs health benefit plans of self-insured, self-funded
employers in the United States is known as:
A) The Employee Retirement Income Security Act of 1974 (ERISA)
B) Det Norske Veritas
C) The 1986 Consolidated Omnibus Budget Reconciliation Act (COBRA)
D) The Health Maintenance Organization Act of 1973
Answer:
A) The Employee Retirement Income Security Act of 1974 (ERISA)
,Question:
To promote healthcare quality through accreditation and certification
programs, is the purpose of:
A) URAC
B) ERISA
C) COBRA
D) EMTALA
Answer:
A) URAC
Question:
The law that encompasses all health benefit issues of a self-funded health
insurance plan, including administrator competence, is called the:
A) HMO Act
B) Employee Self-Funded Plan Act (ESPA)
C) Employee Retirement Income Security Act (ERISA)
D) Affordable Care Act (ACA)
Answer:
C) Employee Retirement Income Security Act (ERISA)
,Question:
Hospitals, health systems, and large physician groups are likely to have robust
governance models with supporting organizational infrastructure to oversee
and carry out managed care operations. Small Physician groups could have all
of the following, EXCEPT:
A) Relationships with large provider organizations to share managed care
operations
B) Outsource managed care operations
C) Similar operations only for chargemaster price estimation
D) Reliance on a core set of individuals to direct and administer managed care
operations
Answer:
C) Similar operations only for chargemaster price estimation
Question:
The Patient Centered Medical Home model is expected to reduce costs by:
A) All of the above
B) Reducing emergency room visits
C) Reducing inpatient admissions
D) Increasing preventive care
Answer:
A) All of the above
, Question:
One way that the term carve-out is used when discussing managed care is:
A) Referring to benefits that are administered separately from the rest of
Medicaid
B) Referring to specific benefits or services that are administered together
with the rest of managed care plan
C) Referring to a broad range of benefits or services that are administered
separately from the rest of the managed care plan
D) Referring to specific benefits or services that are administered separately
from the rest of the managed care plan
Answer:
D) Referring to specific benefits or services that are administered separately
from the rest of the managed care plan
Question:
The following are quality-related outcomes that can be measured except:
A) Transplant quality indicators
B) Risk-adjusted mortality rates
C) Level of physician compensation
D) Readmission rates
Answer:
C) Level of physician compensation
