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CSPR newest 2026 - CERTIFIED
SPECIALIST PAYMENT exam
questions and answers already graded
A+. exams of nursing.
How is the term carve-out used when discussing
managed care? - ANSWER ->To refer to specific benefits
or services
What is the term Coordination of Benefits (COB)? -
ANSWER ->A term used to describe how payment is
coordinated for patients who have coverage through two
insurance policies
Which three components are used to determine the total
RVU value for a service? - ANSWER ->-Malpractice
expense
-Lowest market price for services used
-Medicare discounts
,A fixed payment amount based upon the number of
members assigned to a provider, and does not vary
based upon the number of services rendered, is known
as: - ANSWER ->Capitation
Aligning incentives has come to mean _________. -
ANSWER ->The appropriate addition of some risk in the
exchange of health care to a patient for some form of
remuneration.
According to MedPAC, which option is a benefit or
undesirable consequence of bundling payments? -
ANSWER ->-It allows Medicare to pay a set fee per
hospitalization episode.
-It would provide the potential to improve efficiency and
quality
-It would lead to underutilization of services
As the healthcare industry moves to control growth in
medical spending, what initiative can help hospitals
maintain their margins? - ANSWER ->Contract
standardization
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As the healthcare industry moves to control growth in
medical spending, what initiative can NOT help hospitals
maintain their margins? - ANSWER ->-Pay-
forperformance programs -Health savings accounts
-Price transparency
Identify which initiatives are focused on in an effort to
help increase an organization's revenue/profit /margins.
- ANSWER ->-Health plan consolidation
-Payment policing and standardization of contract
requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
What are rating tiers? - ANSWER ->Different rates
charged on the basis of the number and relationships
What is the role of reinsurance? - ANSWER -
>Reinsurance seeks to limit a policyholder's liability for
catastrophic claims
Which option is a major trend in case management? -
ANSWER ->-Shift from broad-based toward more focused
efforts
, -Reduction of administrative costs
-Greater physician involvement
What type of provider authorization is applied in
emergency cases, where prior authorization is
impossible? - ANSWER ->Concurrent
What is utilization management (UM)? - ANSWER ->A
tool to control the costs of providing healthcare services
to enrollees
Which of the following statements is true about disease
management (DM)? - ANSWER ->DM programs
encourage patients to assume some control over their
disease state
What is the function of catastrophic case management
(CM)? - ANSWER ->It is used to manage diseases in
patients with very high costs of care.
What is demand management? - ANSWER ->A
coordinated effort by the MCO, employers, and
providers to control the utilization of medical services
and resources
CSPR newest 2026 - CERTIFIED
SPECIALIST PAYMENT exam
questions and answers already graded
A+. exams of nursing.
How is the term carve-out used when discussing
managed care? - ANSWER ->To refer to specific benefits
or services
What is the term Coordination of Benefits (COB)? -
ANSWER ->A term used to describe how payment is
coordinated for patients who have coverage through two
insurance policies
Which three components are used to determine the total
RVU value for a service? - ANSWER ->-Malpractice
expense
-Lowest market price for services used
-Medicare discounts
,A fixed payment amount based upon the number of
members assigned to a provider, and does not vary
based upon the number of services rendered, is known
as: - ANSWER ->Capitation
Aligning incentives has come to mean _________. -
ANSWER ->The appropriate addition of some risk in the
exchange of health care to a patient for some form of
remuneration.
According to MedPAC, which option is a benefit or
undesirable consequence of bundling payments? -
ANSWER ->-It allows Medicare to pay a set fee per
hospitalization episode.
-It would provide the potential to improve efficiency and
quality
-It would lead to underutilization of services
As the healthcare industry moves to control growth in
medical spending, what initiative can help hospitals
maintain their margins? - ANSWER ->Contract
standardization
,3|Page
As the healthcare industry moves to control growth in
medical spending, what initiative can NOT help hospitals
maintain their margins? - ANSWER ->-Pay-
forperformance programs -Health savings accounts
-Price transparency
Identify which initiatives are focused on in an effort to
help increase an organization's revenue/profit /margins.
- ANSWER ->-Health plan consolidation
-Payment policing and standardization of contract
requirements
-Shift in volume and cost risk to hospitals
-Contract performance modeling
What are rating tiers? - ANSWER ->Different rates
charged on the basis of the number and relationships
What is the role of reinsurance? - ANSWER -
>Reinsurance seeks to limit a policyholder's liability for
catastrophic claims
Which option is a major trend in case management? -
ANSWER ->-Shift from broad-based toward more focused
efforts
, -Reduction of administrative costs
-Greater physician involvement
What type of provider authorization is applied in
emergency cases, where prior authorization is
impossible? - ANSWER ->Concurrent
What is utilization management (UM)? - ANSWER ->A
tool to control the costs of providing healthcare services
to enrollees
Which of the following statements is true about disease
management (DM)? - ANSWER ->DM programs
encourage patients to assume some control over their
disease state
What is the function of catastrophic case management
(CM)? - ANSWER ->It is used to manage diseases in
patients with very high costs of care.
What is demand management? - ANSWER ->A
coordinated effort by the MCO, employers, and
providers to control the utilization of medical services
and resources
