CSPR ACTUAL EXAM SCRIPT 2026
QUESTIONS AND SOLUTIONS GRADED A+
◉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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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?
QUESTIONS AND SOLUTIONS GRADED A+
◉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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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. Answer: 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?
