HFMA CSPR with correct answers
The No Surprise Act was a product of:
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A) The Health Insurance Portability Act
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B) The Consolidation Appropriations Act
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C) The Treaty of Algeron
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D) The Affordable Care Act - answersD) The Affordable Care Act
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Which of the following is an advantage of direct contracting?
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A) Providers do not have to adjudicate claims for payment
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B) Employers can save the cost of working with an insurance company
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C) It allows the patients to have a choice of providers and physicians
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D) Providers can work directly with employers to reduce the cost of providing insurance
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- answersD) Providers can work directly with employers to reduce the cost of providing
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insurance
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Accountable Care Organizations (ACOs) have all of the following characteristics
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EXCEPT:
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A) Patient centric care model
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B) Financial incentive for quantity of care
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C) Integrated care coordination
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D) Electronic Medical Record System - answersB) Financial incentive for quantity of
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care
m
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient
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may be transferred from one hospital to another when in a(n) condition:
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A) Life threatening
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B) Non-emergency
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C) Stable
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D) Chronic - answersA) Life threatening
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STAR ratings are used to indicate the quality of:
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A) Accountable Care Organizations performance
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B) Medicare Advantage health plan performance
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C) Services provided by hospitals
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D) Services provided by physicians - answersB) Medicare Advantage health plan
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performance
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,To evaluate an organization's compliance with the CMS COP standards and other
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accreditation requirements, is the purpose of:
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A) A comprehensive accreditation process
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B) Recovery Audits
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C) The American Osteopathic Association
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D) A clean claim - answersA) A comprehensive accreditation process
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What is tiering? m m
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per
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episode of care
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B) Healthcare coverage products featuring narrow networks, high cost sharing and very
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low premiums
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C) An effort by insurers to increase premiums and to address calls from employers and
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the public for improved quality
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D) The ranking or classifying of one or more of the provider delivery system
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components to influence choice - answersD) The ranking or classifying of one or more
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of the provider delivery system components to influence choice
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Which piece of information is NOT necessary for claims processing?
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A) Provider or referring provider identification
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B) Family medical history
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C) Type of service
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D) Procedure code - answersB) Family medical history
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Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation
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ACT (COBRA)?
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A) COBRA beneficiaries generally are eligible for group coverage during a maximum of
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48 months for qualifying events
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B) COBRA coverage begins on the date that healthcare coverage would otherwise have
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been lost because of a qualifying event
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C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying
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events to be eligible for benefits
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D) Group health coverage for COBRA participants is usually more expensive than
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health coverage for active employee - answersA) COBRA beneficiaries generally are
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eligible for group coverage during a maximum of 48 months for qualifying events
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, Which of the following is a managed care trend that can reduce utilization and costs
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because patients pay higher out-of-pockeet amounts?
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A) Requirements for participation in Medicare managed care plans
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B) Growth in high-deductible health plans with a Health Savings (HSA) option
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C) Growth in participation in Medicaid managed care plans
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D) Growth in participation in Medicare managed care plans - answersB) Growth in high-
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deductible health plans with a Health Savings (HSA) option
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A Medicare Advanced Beneficiary Notice (ABN) provides the following:
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A) Notifies member of alternative covered services
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B) Notifies member of a non-authorized procedure
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C) Notifies member of non-covered service
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D) Notifies member of guaranteed payment - answersC) Notifies member of non-
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covered service m
The appropriate addition of some risk in the exchange of health care to a patient for
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some form of remuneration, is also known as:
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A) Diagnosis-related groups (DRG's)
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B) Per diems
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C) Fee-for-Service reimbursement
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D) Aligning incentives - answersB) Per diems
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The federal government pays a share of the medical assistance expenditures under
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each state's Medicaid program. How is that share, known as the federal medical
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assistance percentage (FMAP), determined?
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A) None of the above
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B) By using a formula that compares the states average per capita income level with the
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national income average
m m m
C) By ranking states according to the percentage of residents at the poverty level
m m m m m m m m m m m m m m
D) By averaging the percentage paid in the five previous years - answersB) By using a
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formula that compares the states average per capita income level with the national
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income average
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The different rates charged on the basis of the number and relationships of the people
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covered under one employee's plan is known as:
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A) Ratings
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B) Rating tiers
m m
C) Structures
m
D) Tier structures - answersB) Rating tiers
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A Patient Centered Medical Home has all the following characteristics except:
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The No Surprise Act was a product of:
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A) The Health Insurance Portability Act
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B) The Consolidation Appropriations Act
m m m m
C) The Treaty of Algeron
m m m m
D) The Affordable Care Act - answersD) The Affordable Care Act
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Which of the following is an advantage of direct contracting?
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A) Providers do not have to adjudicate claims for payment
m m m m m m m m m
B) Employers can save the cost of working with an insurance company
m m m m m m m m m m m
C) It allows the patients to have a choice of providers and physicians
m m m m m m m m m m m m
D) Providers can work directly with employers to reduce the cost of providing insurance
m m m m m m m m m m m m m
- answersD) Providers can work directly with employers to reduce the cost of providing
m m m m m m m m m m m m m m
insurance
m
Accountable Care Organizations (ACOs) have all of the following characteristics
m m m m m m m m m
EXCEPT:
m m
A) Patient centric care model
m m m m
B) Financial incentive for quantity of care
m m m m m m
C) Integrated care coordination
m m m m
D) Electronic Medical Record System - answersB) Financial incentive for quantity of
m m m m m m m m m m m
care
m
The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient
m m m m m m m m m m m
may be transferred from one hospital to another when in a(n) condition:
m m m m m m m m m m m m m
A) Life threatening
m m
B) Non-emergency
m
C) Stable
m
D) Chronic - answersA) Life threatening
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STAR ratings are used to indicate the quality of:
m m m m m m m m m
A) Accountable Care Organizations performance
m m m m m
B) Medicare Advantage health plan performance
m m m m m
C) Services provided by hospitals
m m m m m
D) Services provided by physicians - answersB) Medicare Advantage health plan
m m m m m m m m m m
performance
m
,To evaluate an organization's compliance with the CMS COP standards and other
m m m m m m m m m m m
accreditation requirements, is the purpose of:
m m m m m m m
A) A comprehensive accreditation process
m m m m
B) Recovery Audits
m m
C) The American Osteopathic Association
m m m m m
D) A clean claim - answersA) A comprehensive accreditation process
m m m m m m m m m
What is tiering? m m
A) Typically fixed dollar amounts paid by the insured directly to the practitioner per
m m m m m m m m m m m m m
episode of care
m m m
B) Healthcare coverage products featuring narrow networks, high cost sharing and very
m m m m m m m m m m m
low premiums
m m m
C) An effort by insurers to increase premiums and to address calls from employers and
m m m m m m m m m m m m m m
the public for improved quality
m m m m m
D) The ranking or classifying of one or more of the provider delivery system
m m m m m m m m m m m m m
components to influence choice - answersD) The ranking or classifying of one or more
m m m m m m m m m m m m m m
of the provider delivery system components to influence choice
m m m m m m m m m
Which piece of information is NOT necessary for claims processing?
m m m m m m m m m
A) Provider or referring provider identification
m m m m m
B) Family medical history
m m m
C) Type of service
m m m
D) Procedure code - answersB) Family medical history
m m m m m m m
Which option is NOT true concerning the Consolidated Omnibus Budget Reconciliation
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ACT (COBRA)?
m m
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of
m m m m m m m m m m m m
48 months for qualifying events
m m m m m
B) COBRA coverage begins on the date that healthcare coverage would otherwise have
m m m m m m m m m m m m
been lost because of a qualifying event
m m m m m m m
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying
m m m m m m m m m m
events to be eligible for benefits
m m m m m m
D) Group health coverage for COBRA participants is usually more expensive than
m m m m m m m m m m m
health coverage for active employee - answersA) COBRA beneficiaries generally are
m m m m m m m m m m m
eligible for group coverage during a maximum of 48 months for qualifying events
m m m m m m m m m m m m m
, Which of the following is a managed care trend that can reduce utilization and costs
m m m m m m m m m m m m m m
because patients pay higher out-of-pockeet amounts?
m m m m m m
A) Requirements for participation in Medicare managed care plans
m m m m m m m m m
B) Growth in high-deductible health plans with a Health Savings (HSA) option
m m m m m m m m m m m
C) Growth in participation in Medicaid managed care plans
m m m m m m m m m
D) Growth in participation in Medicare managed care plans - answersB) Growth in high-
m m m m m m m m m m m m m
deductible health plans with a Health Savings (HSA) option
m m m m m m m m
A Medicare Advanced Beneficiary Notice (ABN) provides the following:
m m m m m m m m m
A) Notifies member of alternative covered services
m m m m m m m
B) Notifies member of a non-authorized procedure
m m m m m m
C) Notifies member of non-covered service
m m m m m
D) Notifies member of guaranteed payment - answersC) Notifies member of non-
m m m m m m m m m m m
covered service m
The appropriate addition of some risk in the exchange of health care to a patient for
m m m m m m m m m m m m m m m
some form of remuneration, is also known as:
m m m m m m m m m
A) Diagnosis-related groups (DRG's)
m m m
B) Per diems
m m
C) Fee-for-Service reimbursement
m m m
D) Aligning incentives - answersB) Per diems
m m m m m m
The federal government pays a share of the medical assistance expenditures under
m m m m m m m m m m m
each state's Medicaid program. How is that share, known as the federal medical
m m m m m m m m m m m m m
assistance percentage (FMAP), determined?
m m m m
A) None of the above
m m m m
B) By using a formula that compares the states average per capita income level with the
m m m m m m m m m m m m m m m
national income average
m m m
C) By ranking states according to the percentage of residents at the poverty level
m m m m m m m m m m m m m m
D) By averaging the percentage paid in the five previous years - answersB) By using a
m m m m m m m m m m m m m m m
formula that compares the states average per capita income level with the national
m m m m m m m m m m m m m
income average
m m
The different rates charged on the basis of the number and relationships of the people
m m m m m m m m m m m m m m
covered under one employee's plan is known as:
m m m m m m m m
A) Ratings
m
B) Rating tiers
m m
C) Structures
m
D) Tier structures - answersB) Rating tiers
m m m m m m
A Patient Centered Medical Home has all the following characteristics except:
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