CSPR CERTIFICATION EVALUATION 2026
EXAM SCRIPT FULLY SOLVED QUESTION
SET
◉ACA. Answer: Affordable Care Act
◉HMO (Health Maintenance Organization). Answer: The
organization is both the insurer and provider of a set of defined
services. Patients within this network must use an in-network
provider for their services to be covered.
◉Capitation Payment. Answer: part of prospective payment in
which healthcare providers receive fixed monthly payments for
services rendered regardless of whether or not services are used
◉PPO (Preferred Provider Organization). Answer: A network of
healthcare providers, such as hospitals and physicians. They have
entered into a contract with a third-party entitled to deliver
healthcare services to individuals covered under the plan.
◉POS. Answer: Combines the features of both an HMO and PPO,
with costs for covered persons falling somewhere between the two.
,Required to have a PCP, but can self refer to other in-network
specialists.
◉EPO. Answer: Services are covered only if patients use doctors,
specialists or hospitals in the plan's network. There are no out of
network benefits.
◉ACO. Answer: Accountable Care Organization
◉What employer-based insurance was first?. Answer: Blue Cross
◉ERISA (Employee Retirement Income Security Act). Answer:
Federal law that sets minimum standards for most voluntarily
established pension and health plans in private industry to provide
protection for individuals in these plans.
◉Government health Coverage Examples. Answer: Medicare and
Medicaid
◉Medicare Managed Care Plans. Answer: These plans charge a
monthly premium and a small copayment for each office visit, but
not a deductible. Like private payer managed care plans, these plans
often require patients to use a specific network of physicians,
hospitals, and facilities. Some plans offer the option of receiving
services from providers outside the network for a higher fee.
, Participants are generally required to select a primary care provider
(PCP) from within the network.
◉Medicaid Managed Care. Answer: Plans that operate under the
terms of waivers filed by the state Medicaid agencies requesting that
a program be established that varies from the traditional Medicaid
program.
◉Medicare Parts. Answer: - part a (inpatient hospital care)
- part b (MD and outpatient care)
- part c (managed care option)
- part d (prescription drugs)
◉Which of the following is an anticipated change in the relationship
between consumers and providers?. Answer: Providers will face
many new service demands and consumers will have virtually
unfettered access to those services
◉Medicare provides health insurance benefits to the following
individuals.. Answer: All persons age 65, individuals with permanent
renal (kidney) failure, disabilities
◉QMBs. Answer: Medicare beneficiaries who qualify for certain
Medicaid benefits if they have incomes below the FPL and resources
at or below twice the standard allowed under the SSI program.
EXAM SCRIPT FULLY SOLVED QUESTION
SET
◉ACA. Answer: Affordable Care Act
◉HMO (Health Maintenance Organization). Answer: The
organization is both the insurer and provider of a set of defined
services. Patients within this network must use an in-network
provider for their services to be covered.
◉Capitation Payment. Answer: part of prospective payment in
which healthcare providers receive fixed monthly payments for
services rendered regardless of whether or not services are used
◉PPO (Preferred Provider Organization). Answer: A network of
healthcare providers, such as hospitals and physicians. They have
entered into a contract with a third-party entitled to deliver
healthcare services to individuals covered under the plan.
◉POS. Answer: Combines the features of both an HMO and PPO,
with costs for covered persons falling somewhere between the two.
,Required to have a PCP, but can self refer to other in-network
specialists.
◉EPO. Answer: Services are covered only if patients use doctors,
specialists or hospitals in the plan's network. There are no out of
network benefits.
◉ACO. Answer: Accountable Care Organization
◉What employer-based insurance was first?. Answer: Blue Cross
◉ERISA (Employee Retirement Income Security Act). Answer:
Federal law that sets minimum standards for most voluntarily
established pension and health plans in private industry to provide
protection for individuals in these plans.
◉Government health Coverage Examples. Answer: Medicare and
Medicaid
◉Medicare Managed Care Plans. Answer: These plans charge a
monthly premium and a small copayment for each office visit, but
not a deductible. Like private payer managed care plans, these plans
often require patients to use a specific network of physicians,
hospitals, and facilities. Some plans offer the option of receiving
services from providers outside the network for a higher fee.
, Participants are generally required to select a primary care provider
(PCP) from within the network.
◉Medicaid Managed Care. Answer: Plans that operate under the
terms of waivers filed by the state Medicaid agencies requesting that
a program be established that varies from the traditional Medicaid
program.
◉Medicare Parts. Answer: - part a (inpatient hospital care)
- part b (MD and outpatient care)
- part c (managed care option)
- part d (prescription drugs)
◉Which of the following is an anticipated change in the relationship
between consumers and providers?. Answer: Providers will face
many new service demands and consumers will have virtually
unfettered access to those services
◉Medicare provides health insurance benefits to the following
individuals.. Answer: All persons age 65, individuals with permanent
renal (kidney) failure, disabilities
◉QMBs. Answer: Medicare beneficiaries who qualify for certain
Medicaid benefits if they have incomes below the FPL and resources
at or below twice the standard allowed under the SSI program.
