CSPR COMPREHENSIVE EXAMINATION
TEST 2026 FULL QUESTIONS AND
CORRECT ANSWERS
◉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. Answer: 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.
Answer: 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. Answer: 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. Answer: 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.
Answer: 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. Answer: 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. Answer: 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. Answer: D)
Information required for claims processing
◉When modeling the proposed payer's contractual reimbursement,
you should include:
A) All claim data
B) All Medicare claim data
C) All commercial claim data
D) Payer specific claim data. Answer: D) Payer specific claim data
◉Which of the following is not examined in a concurrent utilization
management review?
TEST 2026 FULL QUESTIONS AND
CORRECT ANSWERS
◉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. Answer: 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.
Answer: 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. Answer: 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. Answer: 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.
Answer: 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. Answer: 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. Answer: 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. Answer: D)
Information required for claims processing
◉When modeling the proposed payer's contractual reimbursement,
you should include:
A) All claim data
B) All Medicare claim data
C) All commercial claim data
D) Payer specific claim data. Answer: D) Payer specific claim data
◉Which of the following is not examined in a concurrent utilization
management review?
