CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) VERIFIED QUESTIONS AND DETAILED ANSWERS ALREADY RANKED A+.

CSPR - CERTIFIED SPECIALIST PAYMENT REP (HFMA) VERIFIED QUESTIONS AND DETAILED ANSWERS ALREADY RANKED A+. Which of the following statements regarding employer-based health insurance in the United States is true? - 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: - 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? - 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? - ANSWER - A transition toward new models of health care delivery with corresponding changes system financing and provider reimbursement. Which statement is false concerning ABNs? - ANSWER - ABN began establishing new requirements for managed care plans participating in the Medicare program. Steps used to control costs of managed care include: - ANSWER - Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER - Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred