HFMA CSPR EXAM LATEST QUESTIONS
WITH 100% COMPLETE SOLUTION
ALREADY HIGHLY GRADED FOR A+
STUDENTS
The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care Act - answers D) The Affordable Care Act
Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
C) It allows the patients to have a choice of providers and physicians
D) Providers can work directly with employers to reduce the cost of providing insurance
- answers D) Providers can work directly with employers to reduce the cost of providing
insurance
Accountable Care Organizations (ACOs) have all of the following characteristics
EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record System - answers B) Financial incentive for quantity of
care
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient
may be transferred from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
C) Stable
D) Chronic - answers A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
,D) Services provided by physicians - answers B) Medicare Advantage health plan
performance
To evaluate an organization's compliance with the CMS COP standards and other
accreditation requirements, is the purpose of:
A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claim - answers A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per
episode of care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very
low premiums
C) An effort by insurers to increase premiums and to address calls from employers and
the public for improved quality
D) The ranking or classifying of one or more of the provider delivery system
components to influence choice - answers D) The ranking or classifying of one or more
of the provider delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure code - answers B) Family medical history
Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation
ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of
48 months for qualifying events
B) COBRA coverage begins on the date that healthcare coverage would otherwise have
been lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying
events to be eligible for benefits
,D) Group health coverage for COBRA participants is usually more expensive than
health coverage for active employee - answers A) COBRA beneficiaries generally are
eligible for group coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs
because patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plans - answers B) Growth in
high-deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment - answers C) Notifies member of non-
covered service
The appropriate addition of some risk in the exchange of health care to a patient for
some form of remuneration, is also known as:
A) Diagnosis-related groups (DRG's)
B) Per diems
C) Fee-for-Service reimbursement
D) Aligning incentives - answers B) Per diems
The federal government pays a share of the medical assistance expenditures under
each state's Medicaid program. How is that share, known as the federal medical
assistance percentage (FMAP), determined?
A) None of the above
B) By using a formula that compares the states average per capita income level with the
national income average
C) By ranking states according to the percentage of residents at the poverty level
D) By averaging the percentage paid in the five previous years - answers B) By using a
formula that compares the states average per capita income level with the national
income average
The different rates charged on the basis of the number and relationships of the people
covered under one employee's plan is known as:
A) Ratings
B) Rating tiers
, C) Structures
D) Tier structures - answers B) Rating tiers
A Patient Centered Medical Home has all the following characteristics except:
A) Comprehensive and continuous care
B) Health information technology
C) Limited access to care
D) Team-based care delivery - answers C) Limited access to care
All are areas that a NCQA review covers, EXCEPT:
A) Medical records review & Member rights and responsibilities
B) Credentialing review & Preventive and adaptive health services
C) QA review & UM review
D) Physician rights and responsibilities & Certification review - answers D) Physician
rights and responsibilities & Certification review
They are available to everyone, not just employees of a small business or the self-
employed. This is a benefit of:
A) NCQA
B) CDHP
C) Medicare
D) HSA - answers C) Medicare
Coordination of Benefits is essential to:
A) Identifying the correct primary/secondary insure for proper payment
B) Determining charity care
C) Identifying the patient copay at the time of service
D) Ensuring appropriate care is provided - answers A) Identifying the correct
primary/secondary insure for proper payment
Patient and/or enrollee identification, age, gender, date of service, and diagnosis codes
are all regarded as:
A) Information not necessary for claims processing
B) Required information for health plans reporting
C) Information used to establish expected reimbursement
D) Information required for claims processing - answers D) Information required for
claims processing
When modeling the proposed payer's contractual reimbursement, you should include:
A) All claim data
WITH 100% COMPLETE SOLUTION
ALREADY HIGHLY GRADED FOR A+
STUDENTS
The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care Act - answers D) The Affordable Care Act
Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
C) It allows the patients to have a choice of providers and physicians
D) Providers can work directly with employers to reduce the cost of providing insurance
- answers D) Providers can work directly with employers to reduce the cost of providing
insurance
Accountable Care Organizations (ACOs) have all of the following characteristics
EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record System - answers B) Financial incentive for quantity of
care
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient
may be transferred from one hospital to another when in a(n) condition:
A) Life threatening
B) Non-emergency
C) Stable
D) Chronic - answers A) Life threatening
STAR ratings are used to indicate the quality of:
A) Accountable Care Organizations performance
B) Medicare Advantage health plan performance
C) Services provided by hospitals
,D) Services provided by physicians - answers B) Medicare Advantage health plan
performance
To evaluate an organization's compliance with the CMS COP standards and other
accreditation requirements, is the purpose of:
A) A comprehensive accreditation process
B) Recovery Audits
C) The American Osteopathic Association
D) A clean claim - answers A) A comprehensive accreditation process
What is tiering?
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per
episode of care
B) Healthcare coverage products featuring narrow networks, high cost sharing and very
low premiums
C) An effort by insurers to increase premiums and to address calls from employers and
the public for improved quality
D) The ranking or classifying of one or more of the provider delivery system
components to influence choice - answers D) The ranking or classifying of one or more
of the provider delivery system components to influence choice
Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure code - answers B) Family medical history
Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation
ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of
48 months for qualifying events
B) COBRA coverage begins on the date that healthcare coverage would otherwise have
been lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying
events to be eligible for benefits
,D) Group health coverage for COBRA participants is usually more expensive than
health coverage for active employee - answers A) COBRA beneficiaries generally are
eligible for group coverage during a maximum of 48 months for qualifying events
Which of the following is a managed care trend that can reduce utilization and costs
because patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
D) Growth in participation in Medicare managed care plans - answers B) Growth in
high-deductible health plans with a Health Savings (HSA) option
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
A) Notifies member of alternative covered services
B) Notifies member of a non-authorized procedure
C) Notifies member of non-covered service
D) Notifies member of guaranteed payment - answers C) Notifies member of non-
covered service
The appropriate addition of some risk in the exchange of health care to a patient for
some form of remuneration, is also known as:
A) Diagnosis-related groups (DRG's)
B) Per diems
C) Fee-for-Service reimbursement
D) Aligning incentives - answers B) Per diems
The federal government pays a share of the medical assistance expenditures under
each state's Medicaid program. How is that share, known as the federal medical
assistance percentage (FMAP), determined?
A) None of the above
B) By using a formula that compares the states average per capita income level with the
national income average
C) By ranking states according to the percentage of residents at the poverty level
D) By averaging the percentage paid in the five previous years - answers B) By using a
formula that compares the states average per capita income level with the national
income average
The different rates charged on the basis of the number and relationships of the people
covered under one employee's plan is known as:
A) Ratings
B) Rating tiers
, C) Structures
D) Tier structures - answers B) Rating tiers
A Patient Centered Medical Home has all the following characteristics except:
A) Comprehensive and continuous care
B) Health information technology
C) Limited access to care
D) Team-based care delivery - answers C) Limited access to care
All are areas that a NCQA review covers, EXCEPT:
A) Medical records review & Member rights and responsibilities
B) Credentialing review & Preventive and adaptive health services
C) QA review & UM review
D) Physician rights and responsibilities & Certification review - answers D) Physician
rights and responsibilities & Certification review
They are available to everyone, not just employees of a small business or the self-
employed. This is a benefit of:
A) NCQA
B) CDHP
C) Medicare
D) HSA - answers C) Medicare
Coordination of Benefits is essential to:
A) Identifying the correct primary/secondary insure for proper payment
B) Determining charity care
C) Identifying the patient copay at the time of service
D) Ensuring appropriate care is provided - answers A) Identifying the correct
primary/secondary insure for proper payment
Patient and/or enrollee identification, age, gender, date of service, and diagnosis codes
are all regarded as:
A) Information not necessary for claims processing
B) Required information for health plans reporting
C) Information used to establish expected reimbursement
D) Information required for claims processing - answers D) Information required for
claims processing
When modeling the proposed payer's contractual reimbursement, you should include:
A) All claim data
