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CSPR CERTIFIED SPECIALIST PAYMENT REP HFMA
EXAM NEWEST VERSION ALL 500 QUESTIONS AND
CORRECT ANSWERS LATEST UPDATE JUST
RELEASED THIS YEAR
Question: Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure code - CORRECT ANSWER✔✔B) Family medical history
Question: Which option is NOT true concerning the Consolidated Omnibus Budget
Reconciliation ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48
months for qualifying events
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B) COBRA coverage begins on the date that healthcare coverage would otherwise have been
lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events to
be eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health
coverage for active employee - CORRECT ANSWER✔✔A) COBRA beneficiaries generally are
eligible for group coverage during a maximum of 48 months for qualifying events
Question: Which of the following is a managed care trend that can reduce utilization and costs
because patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
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D) Growth in participation in Medicare managed care plans - CORRECT ANSWER✔✔B) Growth
in high-deductible health plans with a Health Savings (HSA) option
Q:The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care Act - CORRECT ANSWER✔✔D) The Affordable Care Act
Question: Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
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 -
CORRECT ANSWER✔✔D) Providers can work directly with employers to reduce the cost of
providing insurance
Question: Accountable Care Organizations (ACOs) have all of the following characteristics
EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record System - CORRECT ANSWER✔✔B) Financial incentive for quantity
of care
Question: The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient
may be transferred from one hospital to another when in a(n) condition:
A) Life threatening
CSPR CERTIFIED SPECIALIST PAYMENT REP HFMA
EXAM NEWEST VERSION ALL 500 QUESTIONS AND
CORRECT ANSWERS LATEST UPDATE JUST
RELEASED THIS YEAR
Question: Which piece of information is NOT necessary for claims processing?
A) Provider or referring provider identification
B) Family medical history
C) Type of service
D) Procedure code - CORRECT ANSWER✔✔B) Family medical history
Question: Which option is NOT true concerning the Consolidated Omnibus Budget
Reconciliation ACT (COBRA)?
A) COBRA beneficiaries generally are eligible for group coverage during a maximum of 48
months for qualifying events
, Page 2 of 215
B) COBRA coverage begins on the date that healthcare coverage would otherwise have been
lost because of a qualifying event
C) COBRA establishes specific criteria for plans, qualified beneficiaries, and qualifying events to
be eligible for benefits
D) Group health coverage for COBRA participants is usually more expensive than health
coverage for active employee - CORRECT ANSWER✔✔A) COBRA beneficiaries generally are
eligible for group coverage during a maximum of 48 months for qualifying events
Question: Which of the following is a managed care trend that can reduce utilization and costs
because patients pay higher out-of-pockeet amounts?
A) Requirements for participation in Medicare managed care plans
B) Growth in high-deductible health plans with a Health Savings (HSA) option
C) Growth in participation in Medicaid managed care plans
, Page 3 of 215
D) Growth in participation in Medicare managed care plans - CORRECT ANSWER✔✔B) Growth
in high-deductible health plans with a Health Savings (HSA) option
Q:The No Surprise Act was a product of:
A) The Health Insurance Portability Act
B) The Consolidation Appropriations Act
C) The Treaty of Algeron
D) The Affordable Care Act - CORRECT ANSWER✔✔D) The Affordable Care Act
Question: Which of the following is an advantage of direct contracting?
A) Providers do not have to adjudicate claims for payment
B) Employers can save the cost of working with an insurance company
C) It allows the patients to have a choice of providers and physicians
, Page 4 of 215
D) Providers can work directly with employers to reduce the cost of providing insurance -
CORRECT ANSWER✔✔D) Providers can work directly with employers to reduce the cost of
providing insurance
Question: Accountable Care Organizations (ACOs) have all of the following characteristics
EXCEPT:
A) Patient centric care model
B) Financial incentive for quantity of care
C) Integrated care coordination
D) Electronic Medical Record System - CORRECT ANSWER✔✔B) Financial incentive for quantity
of care
Question: The Emergency Treatment and Active Labor Act (EMTALA) governs when a patient
may be transferred from one hospital to another when in a(n) condition:
A) Life threatening
