HFMA CSAF ACCOUNTING AND FINANCE
ACTUAL EXAM 2026 QUESTIONS AND
VERIFIED ANSWERS ALREADY PASSED
⩥ 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
⩥ Identify the various types of private health plan coverage Answer:
HMO
Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings option;
Private - Include higher patient out-of-pocket expenditures for
treatments that can serve to reduce utilization/costs.
⩥ Managed care organizations (MCO) exist primarily in four forms:
Answer: Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
,⩥ Identify the various types of government‐sponsored health coverage:
Answer: Medicare - Government; Beneficiaries enrolled in such plans,
but, participation in these
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select
and enroll in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
⩥ Identify some key drivers of increasing healthcare costs Answer:
Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are designed
to reward volume rather than quality, outcomes, and prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
⩥ Health Maintenance Organizations (HMO) Answer: Referrals
PCP
Patients must use an in-network provider for their services to be
covered.
,Reimbursement - majority of services offered are reimbursed through
capitation payments (PMPM)
⩥ Medicare is composed of four parts: Answer: Part A - provides
inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare benefits (known as
Medicare
Advantage)
Part D - prescription drug coverage
⩥ HMO Act of 1973 Answer: The HMO Act of 1973 gave federally
qualified HMOs the right to mandate that employers offer their product
to their employees under certain conditions. Mandating an employer
meant that employers who had 25 or more employees and were for‐
profit companies were required to make a dual choice available to their
employees.
⩥ 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.
⩥ Which Statement is TRUE concerning ABNs? Answer: -ABNs are not
required for services that are never covered by Medicare.
-An ABN form notifies the patient before he or she receives the service
that it may not be
covered by Medicare and that he or she will need to pay out of pocket.
-Although ABNs can have significant financial implications for the
physician, they also
serve an important fraud and abuse compliance function.
ACTUAL EXAM 2026 QUESTIONS AND
VERIFIED ANSWERS ALREADY PASSED
⩥ 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
⩥ Identify the various types of private health plan coverage Answer:
HMO
Conventional
PPO and POS
HDHP/SO plans - high-deductible health plans with a savings option;
Private - Include higher patient out-of-pocket expenditures for
treatments that can serve to reduce utilization/costs.
⩥ Managed care organizations (MCO) exist primarily in four forms:
Answer: Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Point of Service (POS) Organizations
Exclusive Provider Organizations (EPO)
,⩥ Identify the various types of government‐sponsored health coverage:
Answer: Medicare - Government; Beneficiaries enrolled in such plans,
but, participation in these
plans is voluntary.
Medicaid
Medicaid Managed Care - Medicaid beneficiaries are required to select
and enroll in a managed care plan.
Medicare Managed Care (a.k.a. Medicare Advantage Plans)
⩥ Identify some key drivers of increasing healthcare costs Answer:
Demographics
Chronic Conditions
Provider payment systems - Provider payment systems that are designed
to reward volume rather than quality, outcomes, and prevention
Consumer Perceptions
Health Plan pressure
Physician Relationships
Supply Chain
⩥ Health Maintenance Organizations (HMO) Answer: Referrals
PCP
Patients must use an in-network provider for their services to be
covered.
,Reimbursement - majority of services offered are reimbursed through
capitation payments (PMPM)
⩥ Medicare is composed of four parts: Answer: Part A - provides
inpatient/hospital, hospice, and skilled nursing coverage
Part B - provides outpatient/medical coverage
Part C - an alternative way to receive your Medicare benefits (known as
Medicare
Advantage)
Part D - prescription drug coverage
⩥ HMO Act of 1973 Answer: The HMO Act of 1973 gave federally
qualified HMOs the right to mandate that employers offer their product
to their employees under certain conditions. Mandating an employer
meant that employers who had 25 or more employees and were for‐
profit companies were required to make a dual choice available to their
employees.
⩥ 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.
⩥ Which Statement is TRUE concerning ABNs? Answer: -ABNs are not
required for services that are never covered by Medicare.
-An ABN form notifies the patient before he or she receives the service
that it may not be
covered by Medicare and that he or she will need to pay out of pocket.
-Although ABNs can have significant financial implications for the
physician, they also
serve an important fraud and abuse compliance function.
