HFMA CSPR EXAM QUESTIONS AND CORRE
The cNo cSurprise cAct cwas ca cproduct cof: c
A) cThe cHealth cInsurance cPortability cAct
B) cThe cConsolidation cAppropriations cAct
C) cThe cTreaty cof cAlgeron
D) cThe cAffordable cCare cAct c- cCORRECT cANS✔✔D) cThe cAffordable cCare cAct
Which cof cthe cfollowing cis can cadvantage cof cdirect ccontracting?
A) cProviders cdo cnot chave cto cadjudicate cclaims cfor cpayment
B) cEmployers ccan csave cthe ccost cof cworking cwith can cinsurance ccompany
C) cIt callows cthe cpatients cto chave ca cchoice cof cproviders cand cphysicians
D) cProviders ccan cwork cdirectly cwith cemployers cto creduce cthe ccost cof cproviding cinsurance c- cC
ccan cwork cdirectly cwith cemployers cto creduce cthe ccost cof cproviding cinsurance
Accountable cCare cOrganizations c(ACOs) chave call cof cthe cfollowing ccharacteristics cEXCEPT: c
A) cPatient ccentric ccare cmodel
B) cFinancial cincentive cfor cquantity cof ccare
C) cIntegrated ccare ccoordination c
D) cElectronic cMedical cRecord cSystem c- cCORRECT cANS✔✔B) cFinancial cincentive cfor cquantity
The cEmergency cTreatment cand cActive cLabor cAct c(EMTALA) cgoverns cwhen ca cpatient cmay cbe
cto canother cwhen cin ca(n) ccondition: c
A) cLife cthreatening
B) cNon-emergency
C) cStable
D) cChronic c- cCORRECT cANS✔✔A) cLife cthreatening
STAR cratings care cused cto cindicate cthe cquality cof: c
A) cAccountable cCare cOrganizations cperformance c
B) cMedicare cAdvantage chealth cplan cperformance
C) cServices cprovided cby chospitals c
D) cServices cprovided cby cphysicians c- cCORRECT cANS✔✔B) cMedicare cAdvantage chealth cplan
, A) cProvider cor creferring cprovider cidentification
B) cFamily cmedical chistory
C) cType cof cservice
D) cProcedure ccode c- cCORRECT cANS✔✔B) cFamily cmedical chistory
Which coption cis cNOT ctrue cconcerning cthe cConsolidated cOmnibus cBudget cReconciliation cACT c
A) cCOBRA cbeneficiaries cgenerally care celigible cfor cgroup ccoverage cduring ca cmaximum cof c48 cm
B) cCOBRA ccoverage cbegins con cthe cdate cthat chealthcare ccoverage cwould cotherwise chave cbee
cevent
C) cCOBRA cestablishes cspecific ccriteria cfor cplans, cqualified cbeneficiaries, cand cqualifying cevents
D) cGroup chealth ccoverage cfor cCOBRA cparticipants cis cusually cmore cexpensive cthan chealth cco
cCORRECT cANS✔✔A) cCOBRA cbeneficiaries cgenerally care celigible cfor cgroup ccoverage cduring
cqualifying cevents
Which cof cthe cfollowing cis ca cmanaged ccare ctrend cthat ccan creduce cutilization cand ccosts cbecau
pockeet camounts?
A) cRequirements cfor cparticipation cin cMedicare cmanaged ccare cplans c
B) cGrowth cin chigh-deductible chealth cplans cwith ca cHealth cSavings c(HSA) coption
C) cGrowth cin cparticipation cin cMedicaid cmanaged ccare cplans c
D) cGrowth cin cparticipation cin cMedicare cmanaged ccare cplans c- cCORRECT cANS✔✔B) cGrowth c
cwith ca cHealth cSavings c(HSA) coption
A cMedicare cAdvanced cBeneficiary cNotice c(ABN) cprovides cthe cfollowing: c
A) cNotifies cmember cof calternative ccovered cservices c
B) cNotifies cmember cof ca cnon-authorized cprocedure
C) cNotifies cmember cof cnon-covered cservice
D) cNotifies cmember cof cguaranteed cpayment c- cCORRECT cANS✔✔C) cNotifies cmember cof cnon
The cappropriate caddition cof csome crisk cin cthe cexchange cof chealth ccare cto ca cpatient cfor csome
cknown cas: c
A) cDiagnosis-related cgroups c(DRG's)
B) cPer cdiems
C) cFee-for-Service creimbursement c
D) cAligning cincentives c- cCORRECT cANS✔✔B) cPer cdiems
The cfederal cgovernment cpays ca cshare cof cthe cmedical cassistance cexpenditures cunder ceach cst
cis cthat cshare, cknown cas cthe cfederal cmedical cassistance cpercentage c(FMAP), cdetermined?
A) cNone cof cthe cabove
B) cBy cusing ca cformula cthat ccompares cthe cstates caverage cper ccapita cincome clevel cwith cthe cn
C) cBy cranking cstates caccording cto cthe cpercentage cof cresidents cat cthe cpoverty clevel c
D) cBy caveraging cthe cpercentage cpaid cin cthe cfive cprevious cyears c- cCORRECT cANS✔✔B) cBy c
ccompares cthe cstates caverage cper ccapita cincome clevel cwith cthe cnational cincome caverage
The cdifferent crates ccharged con cthe cbasis cof cthe cnumber cand crelationships cof cthe cpeople ccove
cplan cis cknown cas:
The cNo cSurprise cAct cwas ca cproduct cof: c
A) cThe cHealth cInsurance cPortability cAct
B) cThe cConsolidation cAppropriations cAct
C) cThe cTreaty cof cAlgeron
D) cThe cAffordable cCare cAct c- cCORRECT cANS✔✔D) cThe cAffordable cCare cAct
Which cof cthe cfollowing cis can cadvantage cof cdirect ccontracting?
A) cProviders cdo cnot chave cto cadjudicate cclaims cfor cpayment
B) cEmployers ccan csave cthe ccost cof cworking cwith can cinsurance ccompany
C) cIt callows cthe cpatients cto chave ca cchoice cof cproviders cand cphysicians
D) cProviders ccan cwork cdirectly cwith cemployers cto creduce cthe ccost cof cproviding cinsurance c- cC
ccan cwork cdirectly cwith cemployers cto creduce cthe ccost cof cproviding cinsurance
Accountable cCare cOrganizations c(ACOs) chave call cof cthe cfollowing ccharacteristics cEXCEPT: c
A) cPatient ccentric ccare cmodel
B) cFinancial cincentive cfor cquantity cof ccare
C) cIntegrated ccare ccoordination c
D) cElectronic cMedical cRecord cSystem c- cCORRECT cANS✔✔B) cFinancial cincentive cfor cquantity
The cEmergency cTreatment cand cActive cLabor cAct c(EMTALA) cgoverns cwhen ca cpatient cmay cbe
cto canother cwhen cin ca(n) ccondition: c
A) cLife cthreatening
B) cNon-emergency
C) cStable
D) cChronic c- cCORRECT cANS✔✔A) cLife cthreatening
STAR cratings care cused cto cindicate cthe cquality cof: c
A) cAccountable cCare cOrganizations cperformance c
B) cMedicare cAdvantage chealth cplan cperformance
C) cServices cprovided cby chospitals c
D) cServices cprovided cby cphysicians c- cCORRECT cANS✔✔B) cMedicare cAdvantage chealth cplan
, A) cProvider cor creferring cprovider cidentification
B) cFamily cmedical chistory
C) cType cof cservice
D) cProcedure ccode c- cCORRECT cANS✔✔B) cFamily cmedical chistory
Which coption cis cNOT ctrue cconcerning cthe cConsolidated cOmnibus cBudget cReconciliation cACT c
A) cCOBRA cbeneficiaries cgenerally care celigible cfor cgroup ccoverage cduring ca cmaximum cof c48 cm
B) cCOBRA ccoverage cbegins con cthe cdate cthat chealthcare ccoverage cwould cotherwise chave cbee
cevent
C) cCOBRA cestablishes cspecific ccriteria cfor cplans, cqualified cbeneficiaries, cand cqualifying cevents
D) cGroup chealth ccoverage cfor cCOBRA cparticipants cis cusually cmore cexpensive cthan chealth cco
cCORRECT cANS✔✔A) cCOBRA cbeneficiaries cgenerally care celigible cfor cgroup ccoverage cduring
cqualifying cevents
Which cof cthe cfollowing cis ca cmanaged ccare ctrend cthat ccan creduce cutilization cand ccosts cbecau
pockeet camounts?
A) cRequirements cfor cparticipation cin cMedicare cmanaged ccare cplans c
B) cGrowth cin chigh-deductible chealth cplans cwith ca cHealth cSavings c(HSA) coption
C) cGrowth cin cparticipation cin cMedicaid cmanaged ccare cplans c
D) cGrowth cin cparticipation cin cMedicare cmanaged ccare cplans c- cCORRECT cANS✔✔B) cGrowth c
cwith ca cHealth cSavings c(HSA) coption
A cMedicare cAdvanced cBeneficiary cNotice c(ABN) cprovides cthe cfollowing: c
A) cNotifies cmember cof calternative ccovered cservices c
B) cNotifies cmember cof ca cnon-authorized cprocedure
C) cNotifies cmember cof cnon-covered cservice
D) cNotifies cmember cof cguaranteed cpayment c- cCORRECT cANS✔✔C) cNotifies cmember cof cnon
The cappropriate caddition cof csome crisk cin cthe cexchange cof chealth ccare cto ca cpatient cfor csome
cknown cas: c
A) cDiagnosis-related cgroups c(DRG's)
B) cPer cdiems
C) cFee-for-Service creimbursement c
D) cAligning cincentives c- cCORRECT cANS✔✔B) cPer cdiems
The cfederal cgovernment cpays ca cshare cof cthe cmedical cassistance cexpenditures cunder ceach cst
cis cthat cshare, cknown cas cthe cfederal cmedical cassistance cpercentage c(FMAP), cdetermined?
A) cNone cof cthe cabove
B) cBy cusing ca cformula cthat ccompares cthe cstates caverage cper ccapita cincome clevel cwith cthe cn
C) cBy cranking cstates caccording cto cthe cpercentage cof cresidents cat cthe cpoverty clevel c
D) cBy caveraging cthe cpercentage cpaid cin cthe cfive cprevious cyears c- cCORRECT cANS✔✔B) cBy c
ccompares cthe cstates caverage cper ccapita cincome clevel cwith cthe cnational cincome caverage
The cdifferent crates ccharged con cthe cbasis cof cthe cnumber cand crelationships cof cthe cpeople ccove
cplan cis cknown cas:
