HFMA CSPR EXAM 2025 CERTIFIED SPECIALIST PAYMENT & REIMBURSEMENT NEWEST ACTUAL EXAM WITH VERIFIED QUESTIONS & CORRECT ANSWERS GRADED A+

HFMA CSPR EXAM 2025 CERTIFIED SPECIALIST PAYMENT & REIMBURSEMENT NEWEST ACTUAL EXAM WITH VERIFIED QUESTIONS & CORRECT ANSWERS GRADED A+ The No Surprise Act was a product of: A) The Health Insurance Portability Act B) The Consolidation Appropriations Act C) The Treaty of Algeron D) The Affordable Care Act D) The Affordable Care Act Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation ACT (COBRA)? A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48 months for qualifying events B) COBRA coverage begins on the date that healthcare coverage would otherwise have been lost because of a qualifying event C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events to be eligible for benefits D) Group health coverage for COBRA participants is usually more expensive than health coverage for active employee A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48 months for qualifying events Which of the following is an advantage of direct contracting? A) Providers do not have to adjudicate claims for payment B) Employers can save the cost of working with an insurance company C) It allows the patients to have a choice of providers and physicians D) Providers can work directly with employers to reduce the cost of providing insurance D) Providers can work directly with employers to reduce the cost of providing insurance STAR ratings are used to indicate the quality of: A) Accountable Care Organizations performance B) Medicare Advantage health plan performance C) Services provided by hospitals D) Services provided by physicians B) Medicare Advantage health plan performance To evaluate an organization's compliance with the CMS COP standards and other accreditation requirements, is the purpose of: A) A comprehensive accreditation process B) Recovery Audits C) The American Osteopathic Association D) A clean claim A) A comprehensive accreditation process Accountable Care Organizations (ACOs) have all of the following characteristics EXCEPT: A) Patient centric care model B) Financial incentive for quantity of care C) Integrated care coordination D) Electronic Medical Record System B) Financial incentive for quantity of care The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient may be transferred from one hospital to another when in a(n) condition: A) Life threatening B) Non-emergency C) Stable D) Chronic A) Life threatening What is tiering? A) Typically fixed dollar amounts paid by the insured directly to the practitioner per episode of care B) Healthcare coverage products featuring narrow networks, high cost sharing and very low premiums C) An effort by insurers to increase premiums and to address calls from employers and the public for improved quality D) The ranking or classifying of one or more of the provider delivery system components to influence choice D) The ranking or classifying of one or more of the provider delivery system components to influence choice Which piece of information is NOT necessary for claims processing? A) Provider or referring provider identification B) Family medical history C) Type of service D) Procedure code B) Family medical history Which of the following is a managed care trend that can reduce utilization and costs because patients pay higher out-of-pocket amounts? A) Requirements for participation in Medicare managed care plans B) Growth in high-deductible health plans with a Health Savings (HSA) option C) Growth in participation in Medicaid managed care plans D) Growth in participation in Medicare managed care plans B) Growth in high-deductible health plans with a Health Savings (HSA) option 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 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 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 D) Information required for claims processing