CSPR- CERTIFIED SPECIALIST
PAYMENT REP (HFMA) EXAM
QUESTIONS AND ANSWERS
2026
Capitation
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
,HDHP/SO plans - high-deductible health plans with a savings option; Private -
Include higher patient out-of-pocket expenditures for treatments that can serve
to reduce utilization/costs.
Managed care organizations (MCO) exist primarily in four forms: - ✔✔ CORRECT
ANSWER ✔✔Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
Identify the various types of government-sponsored health coverage: - ✔✔
CORRECT ANSWER ✔✔Medicare - Government; Beneficiaries enrolled in such
plans, but, participation in these plans is voluntary.
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
,Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Demographics
Health Maintenance Organizations (HMO) - ✔✔ CORRECT ANSWER ✔✔Referrals
PCP
Patients must use an in-network provider for their services to be covered.
Reimbursement - majority of services offered are reimbursed through capitation
payments (PMPM)
Medicare is composed of four parts: - ✔✔ CORRECT ANSWER ✔✔Part A -
provides inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare benefits (known as Medicare
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
, Advantage)
Part D - prescription drug coverage
HMO Act of 1973 - ✔✔ CORRECT ANSWER ✔✔The HMO Act of 1973 gave
federally qualified HMOs the right to mandate that employers offer their product
to their employees under certain conditions. Mandating an employer meant that
employers who had 25 or more employees and were for-profit companies were
required to make a dual choice available to their employees.
Which of the following statements regarding employer-based health insurance in
the United States is true? - ✔✔ CORRECT ANSWER ✔✔The real advent of
employer-based insurance came through Blue Cross, which was started by
hospital associations during the Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave qualified HMOs
the right to "mandate" an employer under certain conditions, meaning
employers: - ✔✔ CORRECT ANSWER ✔✔Would have to offer HMO plans along
side traditional fee-for-service medical plans.
Which of the following is an anticipated change in the relationships between
consumers and providers? - ✔✔ CORRECT ANSWER ✔✔Providers will face many
new service demands and consumers will have virtually unfettered access to those
services What transition began as a result of the March 2010 healthcare reform
legislation? - ✔✔ CORRECT ANSWER ✔✔A transition toward new models of
health care delivery with corresponding changes system financing and provider
reimbursement.
Which statement is false concerning ABNs? - ✔✔ CORRECT ANSWER ✔✔ABN
began establishing new requirements for managed care plans participating in the
Medicare program.
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
PAYMENT REP (HFMA) EXAM
QUESTIONS AND ANSWERS
2026
Capitation
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
,HDHP/SO plans - high-deductible health plans with a savings option; Private -
Include higher patient out-of-pocket expenditures for treatments that can serve
to reduce utilization/costs.
Managed care organizations (MCO) exist primarily in four forms: - ✔✔ CORRECT
ANSWER ✔✔Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
Identify the various types of government-sponsored health coverage: - ✔✔
CORRECT ANSWER ✔✔Medicare - Government; Beneficiaries enrolled in such
plans, but, participation in these plans is voluntary.
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
,Medicare Managed Care (a.k.a. Medicare Advantage Plans)
Demographics
Health Maintenance Organizations (HMO) - ✔✔ CORRECT ANSWER ✔✔Referrals
PCP
Patients must use an in-network provider for their services to be covered.
Reimbursement - majority of services offered are reimbursed through capitation
payments (PMPM)
Medicare is composed of four parts: - ✔✔ CORRECT ANSWER ✔✔Part A -
provides inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare benefits (known as Medicare
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
, Advantage)
Part D - prescription drug coverage
HMO Act of 1973 - ✔✔ CORRECT ANSWER ✔✔The HMO Act of 1973 gave
federally qualified HMOs the right to mandate that employers offer their product
to their employees under certain conditions. Mandating an employer meant that
employers who had 25 or more employees and were for-profit companies were
required to make a dual choice available to their employees.
Which of the following statements regarding employer-based health insurance in
the United States is true? - ✔✔ CORRECT ANSWER ✔✔The real advent of
employer-based insurance came through Blue Cross, which was started by
hospital associations during the Depression.
The Health Maintenance Organization (HMO) Act of 1973 gave qualified HMOs
the right to "mandate" an employer under certain conditions, meaning
employers: - ✔✔ CORRECT ANSWER ✔✔Would have to offer HMO plans along
side traditional fee-for-service medical plans.
Which of the following is an anticipated change in the relationships between
consumers and providers? - ✔✔ CORRECT ANSWER ✔✔Providers will face many
new service demands and consumers will have virtually unfettered access to those
services What transition began as a result of the March 2010 healthcare reform
legislation? - ✔✔ CORRECT ANSWER ✔✔A transition toward new models of
health care delivery with corresponding changes system financing and provider
reimbursement.
Which statement is false concerning ABNs? - ✔✔ CORRECT ANSWER ✔✔ABN
began establishing new requirements for managed care plans participating in the
Medicare program.
CSPR- CERTIFIED SPECIALIST PAYMENT REP (HFMA) EXAM QUESTIONS AND ANSWERS
