HFMA CSPR EXAM/ HFMA CSPR EXAM PREP
2025/2026 WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED
ANSWERS |FREQUENTLY TESTED
QUESTIONS AND SOLUTION|ALREADY
GRADED A+|NEWEST|BRAND NEW VERSION
!!|GUARANTEED PASS
Which of the following is not an example of an objective criteria set that may be applied in
utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA
C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation
A) Bundled payment
Integrated healthcare delivery systems are most capable of successfully managing which type of
payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation
D) Global capitation
1|Page
,A clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500
B) A properly completed billing form, UB-04 or CMS 1500
To ensure that patients have the education, tools, and support they need to make decisions and
participate in their own care is the goal of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's)
B) A patient-centered medical home (PCMH)
Accountable Care Organizations are designed with the following criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
D) To increase the use of emergency room services
C) To save money by avoiding unnecessary tests
Prospective performance and Retrospective performances are considered:
A) Private health plans
B) Contract performance models
C) Rating tiers
D) Consumer Directed Health Plans (CDHP)
B) Contract performance models
Reporting initiative including: Required Nation Performance Measurement, Voluntary National
Performance Measurement, and Employer Coalition Performance Measure, are all:
A) Group advocacy goals intended to reduced consumer spending
B) Consumer advocacy and healthcare value efforts
2|Page
,C) Healthcare report cards available to the public
D) Reports that contain public information regarding all healthcare issues
C) Healthcare report cards available to the public
Identify which option is NOT a payment type that comprises a large percentage of Medicare
expenditures.
A) Inpatient prospective Payment Systems
B) Outpatient Prospective Payment System
C) Medicare payments to physicians
D) MS-DRG payment
C) Medicare payments to physicians
Which option is NOT a practice used to control the costs of managed care?
A) Delivering services that are reasonable, and payers agree on medical necessity and reimburse
for services
B) Combining services, bundling associated charges, determining an appropriate charge the that
set of services
C) Making advance payment to providers for all services needed to care for a member
D) The payer and provider agreeing on a reasonable payment for each service
C) Making advance payment to providers for all services needed to care for a member
Under Title XIX of the Social Security Act, Medicaid:
A) Mandates medical services for certain individuals and low-income families
B) Advocates medical assistance for certain individuals and low-come families
C) Pays for medical assistance for certain individuals and low-income families
D) Provides medical referrals for certain individuals and low-income families
C) Pays for medical assistance for certain individuals and low-income families
Choice of providers and plans, which is a patient protection for managed Medicare enrollees,
involes:
A) Requiring physicians to disclose to Medicare any financial arrangements that create
3|Page
, incentives limiting care
B) Requiring emergency services to be covered when and where the need arises
C) Requiring plans to provide critical information to consumers, both annually and upon request
D) Requiring that medically necessary services be available to beneficiaries 24 hours a day, 7
days a week
C) Requiring plans to provide critical information to consumers, both annually and upon request
The CMS hopital Value-Based Purchasing (VBP) program links a percentage of a hospital's
payment to performance on quality measures. A component of the hospital's VBP total
performance score is:
A) Patient Experience
B) Access to care
C) Case mix indexes
D) Net margin per case
A) Patient Experience
All of the following are true regarding a non-direct PPO, EXCEPT:
A) Many providers sign such agreements, without understanding that there is little volume
promised in exchange for any preferred rates
B) Many providers sign such agreements, without understanding that there is no specific
steerage to contracted providers
C) The arrangements does not discount provider fees with no incentives for patients to access
the provider's services
D) Such PPO's or networks are national networks
C) The arrangements does not discount provider fees with no incentives for patients to access
the provider's services
Which fixed-rate payment method uses a single price for an inpatient stay, outpatient
procedure, or outpatient diagnosis if charges exceed a threshold dollar amount?
4|Page
2025/2026 WITH ACTUAL CORRECT
QUESTIONS AND VERIFIED DETAILED
ANSWERS |FREQUENTLY TESTED
QUESTIONS AND SOLUTION|ALREADY
GRADED A+|NEWEST|BRAND NEW VERSION
!!|GUARANTEED PASS
Which of the following is not an example of an objective criteria set that may be applied in
utilization management?
A) InterQual
B) HEDIS
C) Milliman
D) NCQA
C) Milliman
Which of the following is a trend in payment for healthcare services?
A) Bundled payment
B) Cost-based payments
C) Care coordination
D) Capitation
A) Bundled payment
Integrated healthcare delivery systems are most capable of successfully managing which type of
payer agreement?
A) Monthly management fee
B) Specialist fee for service
C) Hospital fee for service
D) Global capitation
D) Global capitation
1|Page
,A clean claim is:
A) A properly completed billing form, ICD-10 or CPT-4
B) A properly completed billing form, UB-04 or CMS 1500
C) A properly completed billing form, CMS 1500
D) A properly completed billing form, ICD-10 or CMS 1500
B) A properly completed billing form, UB-04 or CMS 1500
To ensure that patients have the education, tools, and support they need to make decisions and
participate in their own care is the goal of:
A) The Patient Protection and Affordable Care Act (PPACA)
B) A patient-centered medical home (PCMH)
C) Accountable care organizations (ACO's)
D) Managed care organizations (MCO's)
B) A patient-centered medical home (PCMH)
Accountable Care Organizations are designed with the following criteria:
A) To make providers independent of each other
B) To provide no financial incentives for provider cooperation
C) To save money by avoiding unnecessary tests
D) To increase the use of emergency room services
C) To save money by avoiding unnecessary tests
Prospective performance and Retrospective performances are considered:
A) Private health plans
B) Contract performance models
C) Rating tiers
D) Consumer Directed Health Plans (CDHP)
B) Contract performance models
Reporting initiative including: Required Nation Performance Measurement, Voluntary National
Performance Measurement, and Employer Coalition Performance Measure, are all:
A) Group advocacy goals intended to reduced consumer spending
B) Consumer advocacy and healthcare value efforts
2|Page
,C) Healthcare report cards available to the public
D) Reports that contain public information regarding all healthcare issues
C) Healthcare report cards available to the public
Identify which option is NOT a payment type that comprises a large percentage of Medicare
expenditures.
A) Inpatient prospective Payment Systems
B) Outpatient Prospective Payment System
C) Medicare payments to physicians
D) MS-DRG payment
C) Medicare payments to physicians
Which option is NOT a practice used to control the costs of managed care?
A) Delivering services that are reasonable, and payers agree on medical necessity and reimburse
for services
B) Combining services, bundling associated charges, determining an appropriate charge the that
set of services
C) Making advance payment to providers for all services needed to care for a member
D) The payer and provider agreeing on a reasonable payment for each service
C) Making advance payment to providers for all services needed to care for a member
Under Title XIX of the Social Security Act, Medicaid:
A) Mandates medical services for certain individuals and low-income families
B) Advocates medical assistance for certain individuals and low-come families
C) Pays for medical assistance for certain individuals and low-income families
D) Provides medical referrals for certain individuals and low-income families
C) Pays for medical assistance for certain individuals and low-income families
Choice of providers and plans, which is a patient protection for managed Medicare enrollees,
involes:
A) Requiring physicians to disclose to Medicare any financial arrangements that create
3|Page
, incentives limiting care
B) Requiring emergency services to be covered when and where the need arises
C) Requiring plans to provide critical information to consumers, both annually and upon request
D) Requiring that medically necessary services be available to beneficiaries 24 hours a day, 7
days a week
C) Requiring plans to provide critical information to consumers, both annually and upon request
The CMS hopital Value-Based Purchasing (VBP) program links a percentage of a hospital's
payment to performance on quality measures. A component of the hospital's VBP total
performance score is:
A) Patient Experience
B) Access to care
C) Case mix indexes
D) Net margin per case
A) Patient Experience
All of the following are true regarding a non-direct PPO, EXCEPT:
A) Many providers sign such agreements, without understanding that there is little volume
promised in exchange for any preferred rates
B) Many providers sign such agreements, without understanding that there is no specific
steerage to contracted providers
C) The arrangements does not discount provider fees with no incentives for patients to access
the provider's services
D) Such PPO's or networks are national networks
C) The arrangements does not discount provider fees with no incentives for patients to access
the provider's services
Which fixed-rate payment method uses a single price for an inpatient stay, outpatient
procedure, or outpatient diagnosis if charges exceed a threshold dollar amount?
4|Page
