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CSPR - Certified Specialist Payment Rep (HFMA) FINAL
EXAM AND PRACTICE EXAM QUESTIONS 2025/2026
NEWEST ACTUAL EXAM WITH COMPLETE QUESTIONS AND
VERIFIED ANSWERS |ALREADY GRADED A+|
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?
A) Per diem payments
B) Carve-outs
C) Inpatient Stop-Loss
D) Case rate payments - ANSWERS-D) Case rate payments
RBRVS is:
A) The relative weight for calculating MS-DRG payments
B) The relative weight for calculating OPPS payments
C) Mediare physician payment relative weights
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D) Acronym for Real Based Reference Verification System -
ANSWERS-C) Mediare physician payment relative weights
When explaining managed care, the most appropriate time refers
to:
A) The least costly
B) The right amount of care provided (and will be billed and paid
for)
C) Medical intervention at the earliest possible time to prevent a
bad situation from becoming unnecessarily worse
D) The least intensive setting required to provide the care
appropriately - ANSWERS-D) The least intensive setting required
to provide the care appropriately
Detailed contract performance assessments; negotiating-strategy
planning briefs; and financial and volume analysis models are all:
A) Tools used to optimize contract performance
B) Key components of a typical contract audit
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C) Performance evaluation tools
D) Contract evaluation criteria - ANSWERS-A) Tools used to
optimize contract performance
The medical cost ratio is equal to the:
A) Total medical expenses divided by total premiums
B) Total Medicare payments divided by the total premiums
C) Total resource allocation costs divided by total premiums
D) Total medical expenses divided by total revenue - ANSWERS-
A) Total medical expenses divided by total premiums
The payment methodologies that could be used with Accountable
Care Organizations (ACO's) EXCEPT:
A) Fee-for-service payments
B) Risk sharing arrangements
C) Global payments
D) DRG's and APCs - ANSWERS-A) Fee-for-service payments
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CDHPs provide some benefits not found in a typical HMO or
PPO. All are CDHP benefits, EXCEPT:
A) Allowing consumers to purchase coverage for things not
typically covered
B) Consumers being required to track their own claims and
payments
C) Representing an additional benefit plan choice tht adds to the
common dual-choice employer offerings
D) Fewer barriers to physician access - ANSWERS-D) Fewer
barriers to physician access
The legislation that governs health benefit plans of self-insured,
self-funded employers in the United States is known as:
CSPR - Certified Specialist Payment Rep (HFMA) FINAL
EXAM AND PRACTICE EXAM QUESTIONS 2025/2026
NEWEST ACTUAL EXAM WITH COMPLETE QUESTIONS AND
VERIFIED ANSWERS |ALREADY GRADED A+|
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?
A) Per diem payments
B) Carve-outs
C) Inpatient Stop-Loss
D) Case rate payments - ANSWERS-D) Case rate payments
RBRVS is:
A) The relative weight for calculating MS-DRG payments
B) The relative weight for calculating OPPS payments
C) Mediare physician payment relative weights
, Page |2
D) Acronym for Real Based Reference Verification System -
ANSWERS-C) Mediare physician payment relative weights
When explaining managed care, the most appropriate time refers
to:
A) The least costly
B) The right amount of care provided (and will be billed and paid
for)
C) Medical intervention at the earliest possible time to prevent a
bad situation from becoming unnecessarily worse
D) The least intensive setting required to provide the care
appropriately - ANSWERS-D) The least intensive setting required
to provide the care appropriately
Detailed contract performance assessments; negotiating-strategy
planning briefs; and financial and volume analysis models are all:
A) Tools used to optimize contract performance
B) Key components of a typical contract audit
, Page |3
C) Performance evaluation tools
D) Contract evaluation criteria - ANSWERS-A) Tools used to
optimize contract performance
The medical cost ratio is equal to the:
A) Total medical expenses divided by total premiums
B) Total Medicare payments divided by the total premiums
C) Total resource allocation costs divided by total premiums
D) Total medical expenses divided by total revenue - ANSWERS-
A) Total medical expenses divided by total premiums
The payment methodologies that could be used with Accountable
Care Organizations (ACO's) EXCEPT:
A) Fee-for-service payments
B) Risk sharing arrangements
C) Global payments
D) DRG's and APCs - ANSWERS-A) Fee-for-service payments
, Page |4
CDHPs provide some benefits not found in a typical HMO or
PPO. All are CDHP benefits, EXCEPT:
A) Allowing consumers to purchase coverage for things not
typically covered
B) Consumers being required to track their own claims and
payments
C) Representing an additional benefit plan choice tht adds to the
common dual-choice employer offerings
D) Fewer barriers to physician access - ANSWERS-D) Fewer
barriers to physician access
The legislation that governs health benefit plans of self-insured,
self-funded employers in the United States is known as:
