CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
QUESTIONS AND ANSWERS GRADED A+ LATEST UPDATE.
Steps used to control costs of managed care include: ANS >>
Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
DRG is used to classify ANS >> Inpatient admissions for the
purpose of 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 ANS >>
HMO
,CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
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: ANS >> Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
Identify the various types of government-sponsored health
coverage: ANS >> Medicare - Government; Beneficiaries enrolled
in such plans, but, participation in these
plans are voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required
to select and enrol in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
,CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
Identify some key drivers of increasing healthcare costs ANS >>
Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are
designed to reward volume rather than quality, outcomes, and
prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
Health Maintenance Organizations (HMO) ANS >> 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: ANS >> Part A - provides
inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
, CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
Part C - an alternative way to receive your Medicare benefits
(known as Medicare
Advantage)
Part D - prescription drug coverage
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 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? ANS >> The real
advent of employer-based insurance came through Blue Cross,
which was started by hospital associations during the
Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave
qualified HMOs the right to "mandate" an employer under
certain conditions, meaning employers: ANS >> Would have to
offer HMO plans along side traditional fee-for-service medical
plans.
CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
QUESTIONS AND ANSWERS GRADED A+ LATEST UPDATE.
Steps used to control costs of managed care include: ANS >>
Bundled codes
Capitation
Payer and Provider to agree on reasonable payment
DRG is used to classify ANS >> Inpatient admissions for the
purpose of 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 ANS >>
HMO
,CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
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: ANS >> Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
Identify the various types of government-sponsored health
coverage: ANS >> Medicare - Government; Beneficiaries enrolled
in such plans, but, participation in these
plans are voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required
to select and enrol in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
,CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
Identify some key drivers of increasing healthcare costs ANS >>
Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are
designed to reward volume rather than quality, outcomes, and
prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
Health Maintenance Organizations (HMO) ANS >> 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: ANS >> Part A - provides
inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
, CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM
Part C - an alternative way to receive your Medicare benefits
(known as Medicare
Advantage)
Part D - prescription drug coverage
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 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? ANS >> The real
advent of employer-based insurance came through Blue Cross,
which was started by hospital associations during the
Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave
qualified HMOs the right to "mandate" an employer under
certain conditions, meaning employers: ANS >> Would have to
offer HMO plans along side traditional fee-for-service medical
plans.
