Certified Specialist Payment & Reimbursement
Full Exam Review (Qns & Ans)
2025
1. Multiple Choice : What is the primary purpose of managed
care?
- A) Increase physician earnings
- B) Reduce healthcare costs and improve quality
- C) Expand patient access to all services
- D) Replace traditional fee-for-service models entirely
ANS : B
Rationale : Managed care aims to reduce costs and improve
quality through integrated care coordination.
2. Fill-in-the-Blank : Managed care uses ________ to control
healthcare costs and ensure efficiency.
©2025
, ANS : Utilization management
Rationale : Utilization management is essential in managed
care to control costs by monitoring service use.
3. True/False : All managed care plans are required to offer out-
of-network benefits.
ANS : False
Rationale : Some plans, such as HMOs, generally restrict
services to in-network providers.
4. Multiple Response : Which are common types of managed
care plans?
- A) Health Maintenance Organization (HMO)
- B) Preferred Provider Organization (PPO)
- C) Exclusive Provider Organization (EPO)
- D) Indemnity Plan
ANS : A, B, C
Rationale : Indemnity plans are not considered managed care
plans as they do not involve network restrictions or utilization
management.
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©2025
, Essentials of Medicare and Medicaid Managed Care
5. Multiple Choice : What is the focus of Medicare Advantage
(Part C) managed care plans?
- A) Fee-for-service payments
- B) Providing additional benefits not covered under Original
Medicare
- C) Eliminating co-payments
- D) Prioritizing private insurance over government programs
ANS : B
Rationale : Medicare Advantage plans offer additional
benefits such as vision, dental, and wellness services.
6. Fill-in-the-Blank : Medicaid managed care programs aim to
improve healthcare access for ________ populations.
ANS : Low-income
Rationale : Medicaid managed care serves vulnerable and
low-income populations.
7. True/False : Dual-eligible individuals enrolled in both
Medicare and Medicaid may access managed care plans tailored
to their needs.
ANS : True
©2025
Full Exam Review (Qns & Ans)
2025
1. Multiple Choice : What is the primary purpose of managed
care?
- A) Increase physician earnings
- B) Reduce healthcare costs and improve quality
- C) Expand patient access to all services
- D) Replace traditional fee-for-service models entirely
ANS : B
Rationale : Managed care aims to reduce costs and improve
quality through integrated care coordination.
2. Fill-in-the-Blank : Managed care uses ________ to control
healthcare costs and ensure efficiency.
©2025
, ANS : Utilization management
Rationale : Utilization management is essential in managed
care to control costs by monitoring service use.
3. True/False : All managed care plans are required to offer out-
of-network benefits.
ANS : False
Rationale : Some plans, such as HMOs, generally restrict
services to in-network providers.
4. Multiple Response : Which are common types of managed
care plans?
- A) Health Maintenance Organization (HMO)
- B) Preferred Provider Organization (PPO)
- C) Exclusive Provider Organization (EPO)
- D) Indemnity Plan
ANS : A, B, C
Rationale : Indemnity plans are not considered managed care
plans as they do not involve network restrictions or utilization
management.
---
©2025
, Essentials of Medicare and Medicaid Managed Care
5. Multiple Choice : What is the focus of Medicare Advantage
(Part C) managed care plans?
- A) Fee-for-service payments
- B) Providing additional benefits not covered under Original
Medicare
- C) Eliminating co-payments
- D) Prioritizing private insurance over government programs
ANS : B
Rationale : Medicare Advantage plans offer additional
benefits such as vision, dental, and wellness services.
6. Fill-in-the-Blank : Medicaid managed care programs aim to
improve healthcare access for ________ populations.
ANS : Low-income
Rationale : Medicaid managed care serves vulnerable and
low-income populations.
7. True/False : Dual-eligible individuals enrolled in both
Medicare and Medicaid may access managed care plans tailored
to their needs.
ANS : True
©2025
